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Incidences and Risk Factors for Surgical Site Infections in Koutiala, Mali

Surgical Science 2024年第7期15卷 465-469页

作者： Mahamadou Coulibaly Moussa Diassana Issiaka Diarra Bréhima Bengaly Birama Togola Drissa Ouattara Souleymane Sanogo Samuel Kletigui Dembélé Cheick Aka Waigalo Brehima Ballo Drissa Traoré Nouhoum Ongoiba Faculty of Medicine University of Science Technique and Technologies of Bamako Bamako Mali Department of Surgery Koutiala Hospital Koutiala Mali Department of Surgery Sikasso Hospital Sikasso Mali Dpartement de chirurgie Hpital Commune I Bamako Mali Department of Surgery University Hospital Center Point G Bamako Mali Department of Surgery Tominian Hospital Tominian Mali

Purpose: This paper aims to assess the incidences and risk factors for surgical site (ISO) infections in the general surgery department of the Koutiala District Hospital. Patients and Methods: This was a prospective and descriptive study from August 1, 2017 to October 31, 2020 involving all patients who underwent laparotomy in the general surgery department of the Koutiala District Hospital. Patients who were not operated on and who did not have a laparotomy were not included. Age, sex, frequency, patient history, National Nosocomial Infections Surveillance (NNIS) index, time to occur, bacteriological test results and course of infection were analyzed. Results: Fifty patients were registered. The average age was 34.2 ± 21.2 years old. Eleven patients were 60 years old or older. The hospital incidence rate was 4.3% and the community incidence rate was 6.1 cases per 100,000 population. The concept of smoking was noted in 15 patients. Patients were operated on in emergency 84% of cases. Peritonitis was the most common initial lesion with 32% of cases. Our patients had an NNIS index greater than 0 in 84% of cases. The time to develop infection from the surgical site was less than 3 days in 8 patients (16% of cases). Depending on the depth of the infection, it was superficial (cutaneous) in 39 patients (78%) and deep (subcutaneous and organic) in 11 patients (22%). Escherichia coli was the most common germ with 72% followed by staphylococcus aureus at 24%. We noted 22% morbidity. The median length of hospitalization was 9 ± 2.2 days. Conclusion: ISO is common in our service. Prevention and mastery require knowledge of risk factors.

关键词： Surgical Site Infection Incidence Risk Factors Surgery

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Acute ulcerative jejunal diverticulitis:Case report of an uncommon entity

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World Journal of Gastroenterology 2008年第40期14卷 6265-6267页

作者： Wojciech Staszewicz Michel Christodoulou Stefania Proietti Nicolas Demartines Service de chirurgie Viscerale Centre Hospitalier Universitaire Vaudois Service de Radiologie Centre Hospitalier Universitaire Vaudois

Jejunal diverticulosis is a rare entity with variable clinical and anatomical *** reported incidence varies from 0.05% to 6%.Although there is no consensus on the management of asymptomatic jejunal diverticular disease,some complications are potentially life threatening and require early surgical *** report a case of an 88-year-old man investigated for acute abdominal pain with a high biological inflammatory *** of multiple giant jejunal diverticulum was discovered at abdominal computed tomography (CT).As a result of the clinical and biological signs of early peritonitis,an emergency surgical exploration was *** first jejunal loop showed clear signs of jejunal *** segmental jejunum resection with end-to-end anastomosis was *** report confirmed an ulcerative jejunal diverticulitis with imminent perforation and acute local *** patient made an excellent rapid postoperative *** diverticulum is rare but may cause serious *** should be considered a possible etiology of acute abdomen,especially in elderly patients with unusual *** CT is the diagnostic tool of *** best treatment is emergency surgical management.

关键词： Jejunal diverticulum Diverticulitis Surgery Tomography

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Adult-to-adult right lobe living donor liver transplantation:Comparison of endoscopic retrograde cholangiography with standard T2-weighted magnetic resonance cholangiography for evaluation of donor biliary anatomy

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World Journal of Gastroenterology 2006年第36期12卷 5820-5825页

作者： Perdita Wietzke-Braun Felix Braun Dieter Müller Thomas Lorf Burckhardt Ringe Giuliano Ramadori Abteilung für Gastroenterologie und Endokrinologie Georg-August-Universitt Gttingen Germany Klinik für Allgemeine chirurgie und Thorax-chirurgie Universitt Schleswig-Holstein Campus Kiel Germany Abteilung für Diagnostische Radiologie Georg-August-Universitt Gttingen Germany Klinik für Allgemeine chirurgie Georg-August-Universitt Gttingen Germany Center for Liver Pancreas and Biliary Disease Drexel University College of Medicine Philadelphia United States

AIM: To compare the value of endoscopic retrograde cholangiography (ERC) and standard T2-weighted magnetic resonance cholangiography (MRC) in the evaluation process as adult-to-adult right lobe living donor liver transplantation (LDLTx) demands a successful outcome, and exact knowledge of the biliary tree is implicated to avoid biliary complications, ***: After starting the LDLTx program, 18 liver transplant candidates were selected for LDLTx by a stepwise evaluation process. ERC and standard T2-weighted MRC were performed to evaluate the biliary system of the donor liver. The anatomical findings of ERC and MRC mapping were compared using the Ohkubo classification. RESULTS: ERC allowed mapping of the whole biliary system in 15/15 (100%) cases, including 14/15 (93.3%) with biliary variants while routine MRC was only accurate in 2/13 (15.4%) cases. MRC was limited in depicting the biliary system proximal of the hepatic bifurcation. Postoperative biliary complications occurred in 2 donors and 8 recipients. Biliary complications were associated with Ohkubo type C, E or G in 6/8 recipients, and 2/3 recipients with biliary leak received a graft with multiple (≥2) bile ducts. CONCLUSION: Pretransplant ERC is safe and superior over standard MRC for detection of biliary variations that occur with a high frequency. However, precise knowledge of biliary variants did not reduce the incidence of postoperative biliary complications.

关键词： Living donor liver transplantation Donors biliary tree Endoscopic retrograde cholangiography Magnetic resonance cholangiography

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Visceral Leishmaniasis at the National Reference University Hospital Center of N’Djamena (Chad): Epidemiological, Clinical, Diagnostic, Therapeutic and Prognostic Aspects

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Advances in Infectious Diseases 2024年第2期14卷 478-486页

作者： Joseph Mad-Toïngué Mahamat Ali Ahmat Oumaïma Mahamat Djarma Alifa Adjibera Philippe Ali Mahamat Moussa Ngakoutou Rangar Choua Ouchemi Mahamat Ali Bolti Djiddi Ali Sougoudi Mamissou Didi Mahamat Doungous Atim Service des Maladies Infectieuses CHU de Référence Nationale N’Djamena Chad Service de Gastroentérologie et Médecine Interne CHU de Référence Nationale N’Djamena Chad Service de Pneumologie et Phtisiologie CHU de Référence Nationale N’Djamena Chad Service de chirurgie viscérale CHU de Référence Nationale N’Djamena Chad Service de Médecine CHU de la Renaissance N’Djamena Chad

Introduction: leishmaniasis is a group of parasitic diseases caused by a parasite of the genus Leishmania transmitted by the bite of an infected vector called a sandfly. There are four forms. Visceral leishmaniasis is the most severe form. The aim of our work is to study the epidemiological, clinical, diagnostic, therapeutic and prognostic aspects of the disease in the Infectious Diseases Department of the Centre Hospitalier Universitaire de Référence Nationale in N'Djaména. Methodology: Patients were recruited on the basis of clinical signs suggestive of visceral leishmaniasis, i.e. prolonged fever, splenomegaly and altered general condition. Biological confirmation was performed with a rapid diagnostic test using recombinant K39 parasite antigen, which is known to have good specificity and sensitivity. Epidata version 3.1 software was used to process patient data. Results: From 05/04/21 to 15/12/23, 153 positive cases were managed. The mean age of patients was 18 years, with a sex ratio of 9.2. Of these patients, 103 (67.3%) had recently stayed at gold mining sites. Patients testing positive were treated with sodium stibogluconate combined with paromomycin for 17 days. The mortality rate was 13.2%. Conclusion: Leishmaniasis is a serious and little-known disease in Chad. In order to respond to the disease, it is necessary to reinforce the capacities of health structures and to carry out appropriate actions in the outbreaks.

关键词： Visceral Leishmaniasis Gold Mining Sites Chad

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Advanced nonmetastatic hepatocellular carcinoma: curative surgery may be an option

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Hepatobiliary Surgery and Nutrition 2022年第6期11卷 870-872页

作者： Julie Leclerc Ahmet Ayav Service de chirurgie cancerologique digestive hepato-bilio-pancreatique et colo-rectaleCHRU NancyNancyFrance

In this multicentric retrospective study(1),the authors aimed to compare surgery versus Sorafenib(SOR)for the treatment of advanced nonmetastatic hepatocellular carcinoma(HCC).Data were collected from two Italian regi... 详细信息

关键词： surgery hepatocellular metastatic

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Role of immunosuppression and tumor differentiation in predicting recurrence after liver transplantation for hepatocellular carcinoma: A multicenter study of 412 patients

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World Journal of Gastroenterology 2006年第45期12卷 7319-7325页

作者： Thomas Decaens Franoise Roudot-Thoraval Solange Bresson-Hadni Carole Meyer Jean Gugenheim Francois Durand Pierre-Henri Bernard Olivier Boillot Philippe Compagnon Yvon Calmus Jean Hardwigsen Christian Ducerf Georges Philippe Pageaux Sébastien Dharancy Olivier Chazouillères Daniel Cherqui Christophe Duvoux Service d'Hépatologie et de Gastroentérologie AP-HP Hpital Henri Mondor Créteil Unité INSERM 581 France Département de Santé Publique AP-HP Hpital Henri Mondor Créteil France Service d’Hépatologie Hpital Jean Minjoz Besanon France Service de Transplantation Hpital HautefeuilleStrasbourg France Service de chirurgie Digestive Hpital L’Ar-chet 2 Nice France Service d’Hépatologie AP-HP Hpital Beau-jon Clichy France Service d’Hépatologie et de Gastroentéro-logie H?pital Pellegrin Bordeaux France Service de chirurgie Digestive Hpital Edouard Herriot Lyon France Service de chirurgie Digestive Hpital Ponchaillou Rennes France Service de chirurgie Digestive AP-HP HpitalCochin Paris France Service de chirurgie Digestive Hpital laConception Marseille France Service de chirurgie Digestive Hpital de laCroix Rousse Lyon France Fédération Médico-Chirurgicale deMaladies de l’Appareil Digestif Hpital Saint-Eloi MontpellierFrance Service d’Hépatologie et de Gastroentérologie H?pital Claude Huriez Lille France Service d’Hépatologie AP-HP Hpital SAntoine Paris France Service de chirurgie Générale et Digestive APHP Hopital Henri Mondor Créteil France

AIM： To assess pre-orthotopic liver transplantation （OLT） factors that could be evaluated pre-operatively or controlled post-operatively associated with hepatocellular carcinoma （HCC） recurrence and disease-free survival after liver transplantation （LT）.METHODS： Four hundred and twelve patients transplanted for HCC between 1988 and 1998 in 14 French centers, who survived the postoperative period were studied. Kaplan Meier estimates were calculated for 24 variables potentially associated with recurrence of HCC. Uni- and multivariate analyses were conducted to identify independent predictors of recurrence. RESULTS： Overall 5-year disease-free survival was 57.1%. By univariate analysis, variables associated with disease-free survival were： presence of cirrhosis （P = 0.001）, etiology of liver disease （P = 0.03）, α fetoprotein level （〈 200, 200 to 2000, or 〉 2000; P 〈 0.0001）, y-GT activity （N, N to 2N or 〉 2N; P = 0.02）, the number of nodules （1, 2-3 or ≥ 4; P = 0.02）, maximal diameter of the largest nodule （〈 3 cm, 3 to 5 cm or 〉 5 cm; P 〈 0.0001）, the sum of the diameter of the nodules （〈 3 cm, 3 to 5 cm, 5 to 10 cm or 〉10 cm; P 〈 0.0001）, bilobar location （P = 0.01）, preoperative portal thrombosis （P 〈 0.0001）, peri-operative treatment of the tumor （P = 0.002） and chemoembolization （P = 0.03）, tumor differentiation （P = 0.01）, initial type of calcineurin inhibitor （P = 0.003）, the use of antilymphocyte antibodies （P = 0.02）, rejection episodes （P = 0.003） and period of LT （P 〈 0.0001）. By multivariate analysis, 6 variables were independently associated with HCC recurrence： maximal diameter of the largest nodule （P 〈 0.0001）, time of LT （P 〈 0.0001）, tumor differentiation （P 〈 0.0001）, use of anti-lymphocyte antibody （ATG） or anti-CD3 antibody （OKT3）（P = 0.005）, preoperative portal thrombosis （P = 0.06） and the number of nodules （P = 0.06）. CONCLUSION： This study identifies immunosuppression, through the use of ATG or OKT3, as a predictive factor of tumor recur

关键词： Immunosuppression Hepatocellular carcinoma Tumor differentiation Liver transplantation

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Controlled and reversible induction of differentiation and activation of adult human hepatocytes by a biphasic culture technique

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World Journal of Gastroenterology 2005年第14期11卷 2080-2087页

作者： Marcus K.H. Auth Kim A. Boost Kerstin Leckel Wolf-Dietrich Beecken Tobias Engl Dietger Jonas Elsie Oppermann Philip Hilgard Bernd H. Markus Wolf-Otto Bechstein Roman A. Blaheta Universit(a|¨)ts-Kinderklinik Essen Abteilung für Allgemeine P(a|¨)diatrie Germany Zentrum der An(a|¨)sthesiologie und Wiederbelebung Johann Wolfgang Goethe-Universit(a|¨)t Frankfurt am MainGermany Klinik für Allgemein-und Gef(a|¨)βchirurgie Germany Klinik für Urologie und Kinderurologie Zentrum der chirurgie Johann Wolfgang Goethe-Universit(a|¨)tFrankfurt am MainGermany Klinik für Allgemein- und Gef(a|¨)βchirurgie Germany Universit(a|¨)tsklinikum Essen Abteilung für Gastroenterologie und Hepatologie Germany Klinik für Allgemein- und Viszeralchirurgie St(a|¨)dt. Klinikum Kemperhof KoblenzGermany

AIM:Clinical application of human hepatocytes (HC) is hampered by the progressive loss of growth and differentiation in vitro. The object of the study was to evaluate the effect of a biphasic culture technique on expression and activation of growth factor receptors and differentiation of human adult HC. METHODS: Isolated HC were sequentially cultured in a hormone enriched differentiation medium (DM) containing nicotinamide, insulin, transferrin, selenium, and dexame-thasone or activation medium (AM) containing hepatocyte growth factor (HGF), epidermal growth factor (EGF), and granulocyte-macrophage colony-stimulating factor (GMCSF). Expression, distribution and activation of the HC receptors (MET and EGFR) and the pattern of characteristic cytokeratin (CK) filaments were measured by fluorometry, confocal microscopy and Western blotting. RESULTS: In the biphasic culture system, HC underwent repeated cycles of activation (characterized by expression and activation of growth factor receptors) and re-differentiation (illustrated by distribution of typical filaments CK-18 but low or absent expression of CK-19). In AM increased expression of MET and EGFR was associated with receptor translocation into the cytoplasm and induction of atypical CK-19. In DM low expression of MET and EGFR was localized on the cell membrane and CK-19 was reduced. Receptor phosphorylation required embedding of HC in collagen type I gel. CONCLUSION: Control and reversible modulation of growth factor receptor activation of mature human HC can be accomplished in vitro, when defined signals from the extracellular matrix and sequential growth stimuli are provided. The biphasic technique helps overcome dedifferentiation, which occurs during continuous stimulation by means of growth factors.

关键词： Human hepatocytes Differentiation Hepatocyte growth factor Epidermal growth factor HGF receptor EGF receptor Cytokeratin Collagen gel

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Rib Osteosynthesis for Sub-Acute Management of a Flail Chest in a Tertiary Centre in a Low-Middle Income Country of Sub-Saharan Africa: Case Report at Douala Laquintinie Hospital

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Open Journal of Thoracic Surgery 2024年第1期14卷 1-16页

作者： Fabrice Stéphane Arroye Betou Nyankoue Mebouinz Ferdinand Guy Aristide Bang Kobe Folkabo Zephany Banga Nkomo Douglas Moussa Seck Diop Abdoul Lahad Mbeng Marcella Derboise Christelle Biyouma Noel Essomba Souleyman Diatta Handy Eone Daniel Arthur Essomba Hassan Ndiaye Maurice Aurelien Sosso Department of Surgery and Specialties Faculty of Medicine and Biomedical Sciences (FMBS) University of Yaoundé (UYI) Yaoundé Cameroon Department of Surgery and Affiliated Disciplines Douala Laquintinie Hospital Douala Cameroon Department of Surgery and Specialties Yaoundé General Hospital Yaoundé Cameroon Department of Surgery and Specialties Faculty of Medicine and Pharmaceutical Sciences (FMPS) University of Dschang Dschang Cameroon Service de chirurgie Thoracique et Cardiovasculaire Centre Hospitalier Universitaire de Fann Faculté de Médecine de Pharmacie et d’Odontologie Université de Cheikh Anta Diop Dakar Sénégal UFR des Sciences de la Santé Ziguinchor Sénégal

Background: Costal fracture surgical is still a debate, therefore we shall select between early and delay surgical management. Case Report: We are reporting two cases of post road traffic clash delay ribs fractures osteosynthesis involving a 63-year-old man with multistage fractures on the left and pulmonary pinning of one of the costal arches, complicated by a homolateral haemothorax and a 41-year-old man with a bilateral flail chest. Conclusion: The simple postoperative course and the immediate postoperative improvement in the patient’s clinical respiratory condition enabled us to discuss the time frame for management, in this case the indication for early or later surgery.

关键词： Flail Chest Fixation Plate Rib Fracture Osteosynthesis

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Evaluating pediatric ureteropelvic junction obstruction:Dynamic magnetic resonance urography vs renal scintigraphy 99mtechnetium mercaptoacetyltriglycine

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World Journal of Radiology 2024年第3期16卷 49-57页

作者： Yousuf Al-Shaqsi Matthieu Peycelon Annabel Paye-Jaouen Elisabeth Carricaburu Anca Tanase Christine Grapin-Dagorno Alaa El-Ghoneimi Department of Pediatric Surgery Sultan Qaboos University HospitalMuscat 123Oman Service de chirurgie Viscérale et Urologie Pédiatrique Hôpital Universitaire Robert-DebréAssistance-Publique Hôpitaux de ParisParis 75019France Centre de Références Maladies Rares Malformations Rares des Voies Urinaires(MARVU)Paris 97019France Facultéde Médecine Universitéde ParisParis 75006France Service d’Imagerie Pédiatrique Hôpital Universitaire Robert-DebréAssistance-Publique Hôpitaux de ParisParis 75019France UniversitéParis 13 Sorbonne Paris CitéParis 75013France

BACKGROUND Ureteropelvic junction obstruction(UPJO)is a common congenital urinary tract disorder in *** can be diagnosed as early as in utero due to the presence of hydronephrosis or later in life due to symptomatic *** To evaluate the discrepancy between dynamic contrast-enhanced magnetic resonance urography(dMRU)and scintigraphy 99m-technetium mercaptoacetyltriglycine(MAG-3)for the functional evaluation of *** Between 2016 and 2020,126 patients with UPJO underwent surgery at Robert Debré*** these,83 received a prenatal diagnosis,and 43 were diagnosed during *** of the 126 patients underwent surgery based on the clinical situation and postnatal ultrasound findings without undergoing functional imaging *** renal function was evaluated preoperatively using scintigraphy MAG-3(n=28),dMRU(n=53),or both(n=40).In this study,we included patients who underwent surgery for UPJO and scintigraphy MAG-3+dMRU but excluded those who underwent only scintigraphy MAG-3 or *** patients were divided into groups A(10%discrepancy).We examined the discrepancy in split renal function between the two modalities and investigated the possible risk *** The split renal function between the two kidneys was compared in 40 patients(28 boys and 12 girls)using scintigraphy MAG-3 and *** renal function,as determined using both modalities,showed a difference of10%in 9 *** of the relative renal function using dMRU revealed an excellent correlation coefficient with renal scintigraphy MAG-3 for both *** Our findings demonstrated that dMRU is equivalent to scintigraphy MAG-3 for evaluating split renal function in patients with UPJO.

关键词： Uteropelvic junction obstruction Scintigraphy 99m-technetium mercaptoacetyltriglycine Magnetic resonance imaging Dynamic contrast-enhanced magnetic resonance urography

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How to identify better candidate to radioembolization in case of hepatocellular carcinoma and portal vein tumoral thrombosis

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Hepatobiliary Surgery and Nutrition 2019年第1期8卷 63-64页

作者： Giovanni Battista Levi Sandri Michel Rayar Department of Surgical Sciences Sapienza University of RomeRomeItaly Service de chirurgie Hépatobiliaire et Digestive CHU RennesRennesFrance

Hepatocellular carcinoma(HCC)is the most common primary liver cancer and the fifth most common malignant tumor *** resection is a curative treatment for HCC and can be safety performed by a minimally invasive procedure in all liver segments without size limitations(1,2).Nevertheless,some patients are diagnosed with HCC and portal vein tumor thrombosis(PVTT).According to the staging system of the Barcelona Clinic Liver Cancer(BCLC),patients with macrovascular invasion are staged as *** those patients,the prognosis is generally ***,the management of HCC with macrovascular invasion is still ***,recent studies proposed different surgical procedure such as one-stage resection or associating liver partition and portal vein ligation,with promising results(3-5).

关键词： invasion thrombosis Liver

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