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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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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 children.It can be diagnosed as early as in utero due to the presence of hydronephrosis or later in life due to symptomatic occurrence.AIM To evaluate the discrepancy between dynamic contrast-enhanced magnetic resonance urography(dMRU)and scintigraphy 99m-technetium mercaptoacetyltriglycine(MAG-3)for the functional evaluation of UPJO.MetHODS Between 2016 and 2020,126 patients with UPJO underwent surgery at Robert debréHospital.Of these,83 received a prenatal diagnosis,and 43 were diagnosed during childhood.Four of the 126 patients underwent surgery based on the clinical situation and postnatal ultrasound findings without undergoing functional imaging evaluation.Split 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 dMRU.The 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 factors.RESULTS The split renal function between the two kidneys was compared in 40 patients(28 boys and 12 girls)using scintigraphy MAG-3 and dMRU.Differential renal function,as determined using both modalities,showed a difference of10%in 9 children.Calculation of the relative renal function using dMRU revealed an excellent correlation coefficient with renal scintigraphy MAG-3 for both kidneys.CONCLUSION 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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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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Meso-Rex bypass for the management of extrahepatic portal vein obstruction in adults(with video)

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Hepatobiliary & Pancreatic Diseases International 2022年第1期21卷 25-32页

作者： Martin Brichard Samuele Iesari Jan Lerut Raymond Reding Pierre Goffette Laurent Coubeau service de chirurgie et Transplantation Abdominale Cliniques Universitaires Saint-LucUniversitéCatholique de Louvain10 Avenue HippocrateBrussels 1200Belgium Pôle de chirurgie Expérimentale et Transplantation Institut de Recherche Expérimentale et CliniqueUniversitéCatholique de LouvainBrusselsBelgium department of Clinical Sciences and Applied Biotechnology University of L’AquilaL’AquilaItaly department of General Surgery and Kidney Transplantation Fondazione IRCCS Ca’Granda Ospedale Maggiore PoliclinicoMilanItaly service de Radiologie et Imagerie médicale Cliniques Universitaires Saint-LucUniversitéCatholique de LouvainBrusselsBelgium

Background:Extrahepatic portal vein obstruction(EHPVO)results in severe portal hypertension(PHT)leading to severely compromised quality of life.Often,pharmacological and endoscopic management is unable to solve this problem.Restoring hepatic portal flow using meso-Rex bypass(MRB)may solve it.This procedure,uncommon in adult patients,is considered the treatment of choice for EHPVO in children.Methods:From 1997 to 2018,8 male and 6 female adults,with a median age of 51 years(range 22-66)underwent MRB procedure for EHPVO at the University Hospitals Saint-Luc in Brussels,Belgium.Symp-toms of PHT were life altering in all but one patient and consisted of repetitive gastro-intestinal bleedings,sepsis due to portal biliopathy,and/or severe abdominal discomfort.The surgical technique consisted in interposition of a free venous graft or of a prosthetic graft between the superior mesenteric vein and the Rex recess of the left portal vein.Results:Median operative time was 500 min(range 300-730).Median follow-up duration was 22 months(range 2-169).One patient died due to hemorrhagic shock following percutaneous transluminal interven-tion for early graft thrombosis.Major morbidity,defined as Clavien-Dindo score≥III,was 35.7%(5/14).Shunt patency at last follow-up was 64.3%(9/14):85.7%(6/7)of pure venous grafts and only 42.9%(3/7)of prosthetic graft.Symptom relief was achieved in 85.7%(12/14)who became asymptomatic after MRB.Conclusions:Adult EHPVO represents a difficult clinical condition that leads to severely compromised quality of life and possible life-threatening complications.In such patients,MRB represents the only and last resort to restore physiological portal vein flow.Although successful in a majority of patients,this procedure is associated with major morbidity and mortality and should be done in tertiary centers expe-rienced with vascular liver surgery to get the best results.

关键词： Meso-Rex bypass Extrahepatic portal vein obstruction Extrahepatic portal hypertension Portal vein thrombosis Surgical procedure

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Study of Complications of Traditional Treatment. <br/>Member Fractures

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Surgical Science 2020年第10期11卷 289-297页

作者： Louis Traore Laye Toure Moussa Sidibe Mamadou Diallo Aboul Kadri Moussa Mamadou Bassirou Traore Tiéman Coulibaly service de chirurgie orthopédique et traumatologique CHU Gabriel Touré Bamako Mali service de chirurgie orthopédique et traumatologique Hopital Regional de Sikasso Bamako Mali

Introduction: Since the times of our ancestors, traditional medicine has existed to cure all diseases [1]. The objective of this study was to assess the complications of traditional fracture treatment. Patients and Methods: This was a prospective study extending from January 01, 2018 to June 30, 2018, duration of six months. It concerned patients who had traditionally been treated beforehand for traumas with bone lesion in a traditional therapist and who had developed a complication, the definitive management of which was made in the department. Results: This study involved 102 patients, including 71 men (69.6%), with a sex ratio of 2.2. 33 patients or 32.4% were under 15 years old. The average of our patients’ age was 29.61 years with extremes of 2 and 89 years. Pupils/students (44 pupils and 5 students) were the most represented with 49 cases or 48.1% of the cases. The majority of patients (59.8% of cases) were educated or had a basic level. The majority of patients (36.3%) came as motif for a painful swelling. Gangrene was the most common complication with 37 cases or 36.3% of cases. Conclusion: At the end of our study, we have noticed that the traditional preliminary treatment of fractures was based mainly on trial and error. Practicing with inadequate means and measures without respecting the anatomical structures, is a real source of disabling handicaps. We have recorded 38, among the 102 patients who came for a complication of traditional treatment: that is 45.2% amputation, which is deplorable.

关键词： Fracture Complications Traditional Treatments

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Fracture-Dislocations of Lisfranc Joint in Lomé(Togo)

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Open Journal of orthopedics 2016年第1期6卷 16-21页

作者： Atchi Walla Anani Abalo Agbékponou Lagnéblé Sényo Tsolenyanu Tchaa Towoezim N. K. Kombaté Michel Assang Dossim service de chirurgie orthopédique et traumatologique CHU Sylvanus Olympio Lomé Togo service de chirurgie orthopédique et traumatologique de l’hopital Saint-Jean de Dieu d’Afagnan Afagnan Togo

Introduction: The purpose of this prospective study was to describe the clinic pathological varieties of fracture-dislocations of Lisfranc joint and outcome of treatment. Patients and Methods: This study was conducted on 21 cases of fracture-dislocations of the Lisfranc joint treated in our orthopedics trauma unit from 2010 to 2013. We selected middle foot pure dislocations or associated with Lisfranc joint bone fractures. Classification of Myerson was used to characterize the lesions. The results assessment criteria were clinical and radiological for foot and Massari score. Results: Fourteen (14) patients were male. The average age was 34.7 years. Five (5) clinic pathological forms were met by relying on the classification of Myerson;4 cases of type A;5 cases of type B1;B2, 6 cases;4 cases of type C1 and 2 cases of type C2. There were eight cases of pure dislocation and 13 dislocations were associated with fractures (metatarsal in 11 patients, cuneiform in 5 patients, cuboid bone in 2 patients and enucleation fracture of the medial cuneiform in 2 patients). It was noted 10 cases of skin openings. Treatment consisted on open reduction in all patients and stabilization by pin complemented by a foot plaster for 6 weeks. Four (4) immediately arthrodeses were made. All patients were followed up 7 month to 4 years (mean, 30 month). According to the criteria of Massiri, treatment outcomes were excellent in 19% of cases, good in 28%, fair in 30% and poor in 23%. Conclusion: In our context, these lesions are often open and associated with fractures of Lisfranc joint skeleton and treated after a period more or less long and sometimes, we face lesions totally old. Immediately arthrodesis can be a lasting solution and should not be overlooked.

关键词： Dislocation Fracture Lisfranc Joint Pinning

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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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Comparison of alternative arterial anastomosis site during liver transplantation when the recipient’s hepatic artery is unusable

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Hepatobiliary Surgery and Nutrition 2022年第1期11卷 1-12页

作者： Jean Marie Beaurepaire Francesco Orlando Giovanni Battista Levi Sandri Caroline Jezequel Edouard Bardou-Jacquet Christophe Camus Mohamed Lakehal Veronique desfourneaux Aude Merdrignac Elodie Gaignard Alexandre Thobie Damien Bergeat Bernard Meunier Michel Rayar CHU Rennes Service de Chirurgie Hépatobiliaire et DigestiveRennesFrance UniversitéRennes 1 Facultéde MédecineRennesFrance CHU Rennes Service des Maladies du FoieRennesFrance INSERM CIC 1414RennesFrance CHU Rennes Service de Maladies Infectieuses et Réanimation MédicaleRennesFrance

Background:Few studies have analyzed outcomes of liver transplantation(LT)when the recipient hepatic artery(HA)was not usable.Methods:We retrospectively evaluated the outcomes of LT performed using the different alternative sites to HA.Results:Between 2002 and 2017,1,677 LT were performed in our institution among which 141(8.4%)with unusable recipient HA were analyzed.Four groups were defined according to the site of anastomosis:the splenic artery(SA group,n=26),coeliac trunk(CT group,n=12),aorta using or not the donor’s vessel(Ao group,n=91)and aorta using a vascular prosthesis(Ao-P group,n=12)as conduit.The median number of intraoperative red blood cell transfusions was significantly increased in the Ao and Ao-P groups(5,5,8.5 and 16 for SA,CT,Ao and Ao-P group respectively,P=0.002),as well as fresh frozen plasma(4.5,2.5,10,17 for the SA,CT,Ao and Ao-P groups respectively,P=0.001).Hospitalization duration was also significantly increased in the Ao and Ao-P groups(15,16,24,26.5 days for the SA,CT,Ao and Ao-P groups respectively,P<0.001).The occurrence of early allograft dysfunction(EAD)(P=0.07)or arterial complications(P=0.26)was not statistically different.Level of factor V,INR,bilirubin and creatinine during the 7th postoperative days(POD)was significantly improved in the SA group.No difference was observed regarding graft(P=0.18)and patient(P=0.16)survival.Conclusions:In case of unusable HA,intraoperative and postoperative outcomes are improved when using the SA or CT compared to aorta.

关键词： Liver transplantation(LT) hepatic artery(HA) arterial anastomosis splenic artery(SA)

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Feasibility,safety and limits of robotic approach for lymphadenectomy in biliary tumours

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Hepatobiliary Surgery and Nutrition 2023年第3期12卷 404-406页

作者： Julie deyrat Stylianos Tzedakis AP-HP Centre Universitéde ParisGroupe Hospitalier Cochin Port RoyalDMU Cancérologie et spécialités médico-chirurgicalesService de chirurgie hépatobiliairedigestive et endocrinienneParisFrance

We read with great interest the study of Ratti et al.(1)aiming to compare robotic,laparoscopic and open hepatectomies in terms of feasibility,safety and oncological adequacy in surgery for biliary tumours(intrahepatic cholangiocarcinoma,perihilar cholangiocarcinoma and gallbladder cancer).The authors conducted a retrospective monocentric study focusing on the quality of lymphadenectomy,operative time and postoperative morbidity and mortality up to day 90.Using a weighted propensity score analysis by inverse probability of treatment weighting(IPTW),25 patients operated by robotic approach were compared with 97 patients operated by laparoscopy and 113 by laparotomy.

关键词： Robotic minimally invasive lymphadenectomy biliary tumour

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Liver transplantation for perihilar cholangiocarcinoma is not a provocative idea

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Hepatobiliary Surgery and Nutrition 2023年第2期12卷 232-234页

作者： Alexandre Chebaro Heithem Jeddou service de chirurgie Hépatobiliaire et Digestive CHU RennesUniv RennesRennesFrance Inserm EHESPIrset(Institut de recherche en santéenvironnement et travail)-UMR_S 1085Univ RennesRennesFrance

This is a multicenter benchmarking study on liver transplantation(LT)for perihilar cholangiocarcinoma(PHC)after neoadjuvant chemoradiotherapy(1).The study comprises of 134 patients from 2014 to 2018 among whom the majority had underlying primary sclerosing cholangitis(PSC).Dropout rate was available from 4 out of 17 centers and was 28%,primarily for oncological reasons(tumor progression and lymph node invasion).All patients followed neo-adjuvant chemoradiotherapy according to the Mayo(88%)or Mayo-like protocol.Liver grafts originated from brain-dead donors in 61.3%of cases and from living donors in 29.7%of cases.

关键词： Liver invasion patients

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