Dakar medical最新文献

Objective: Describe the epidemiology of stroke among patients hospitalized at the Clinic of Neurology , Fann University, Dakar-Senegal.

Methodology: Retrospectively, sociodemographic, medical history and clinical data were collected for patients hospitalized for stroke from January 1st 2001 to November 1st 2003 and to whom a Computed Tomography scan of the brain was done.

Results: The population of study (314 patients) had a mean age of 61.3 years (+/-13.8) and was composed of 56.1% of women. The mean time of admission was 8.4 days (+/-23.5). The leading risk factors of stroke were hypertension, history of stroke and diabetes. Ischemic stroke represented 60.2%. The occurrence of stroke was associated with coma and hypertension. The letality rate was 24.8%.

Conclusion: It is necessary to develop and implement health education program against risk factors for the population to reduce stroke morbidity and mortality.

Introduction: Diabetic foot is a major complication of diabetes due to its frequency and its high risk of evolution to amputation. We report 105 cases recruited at the diabetes centre Marc Sankale.

Method: It's a prospective study including all diabetic patients who attended the diabetes centre for any foot lesion during a one year period. Besides clinical examination data, results of glycaemia, foot X-ray Doppler and bacteriological analysis of the pus were collected.

Results: foot lesion represented 2.8% of diabetologist causes of consultation. Mean age of occurrence was 55 +/- 14 years in 63% women and 37% men. Diabetes was type 2 in 90% cases, poorly controlled in 63.92 % cases. Foot lesion was dominated by infection (97%), isolated or associated to peripheral vascular disease (32.4%) or neuropathy (13.3%). 67 patients had medical treatment and healed their wounds in 3 months in 76% cases. 38 other cases needed surgery : major amputation (15%), minor amputation (13%) debridment (9%) and revascularization (1%).

Conclusion: Diabetic foot is a frequent reason for consultation at the National diabetes centre. Despite all the improvements made after the implementation of the patient's educational program, treatment starts late because of economical and cultural reasons that increase morbidity.

Veinous pathology is increasingly involved in numerous gynecological and obstetrical conditions. This study describes the histological aspects of uterine vein wall according to age and parity. Uterine vein were taken during autopsy of 50 black women of various age and parity. Necroscopic samples of uterine veins were taken from 50 black women of various and diverse age and parity. Microscopic stains were used to assess histological modifications of veinous walls according to age and parity. The disorganization of elastic fibers, collagen fibers of the media, the muscular wall and elastic fibers of the adventice increased with age. The main histological modifications associated with increasing parity were the increase of collagen tissue and the disorganization of the veinous wall. This study provides useful information for other studies regarding the histological analysis of pelvic veins removed during caesarian section for vascular pathology such eclampsia, abruption.

Introduction: The pathogenic capacity of S. aureus is related.to the production of many virulence factors of which the coagulase. Several genotypes of coagulase were described and are associated to various populations of S. aureus. According the susceptibility to methicillin, methicillin-resistant strains of S. aureus, are described. The aim of this subject was to study the coagulase expression of Staphylococcus aureus according to the site of infection, patient origin and the resistance against methicillin.

Material and methods: The study is related about 180 strains of S. aureus collected in the three University Teaching Hospital of Abidjan. S. aureus are identified with laboratory classical methods. Coagulase delay was determined by the test of the coagulase on citrated rabbit plasma at 2, 4 and 18 hours. The resistance against methicillin was researched by disc diffusion agar technique.

Results: In 60% of cases, the bacterial strains gave a coagulum at the end of four hours, fast coagulase, against 40% of strains whose coagulating activity appeared at 18 h, slow coagulase. Fast coagulase strains are isolated from the majority of infections (55% to 71%), in hospital patients (66%) and in paediatrics (58%). Fast coagulase strains are methicillin-resistant in 65% of cases against 48.5% of methicillin-susceptible and low coagulase strains (p < 0.0001).

Conclusion: According to the production lead time of the coagulase, fast coagulase and slow coagulase variants of S. aureus coexisted. The expression of the coagulase is not related to the site of infection and the origin of the patients. On the other hand, the type of coagulase is associated to resistance of methicillin. However, the time of formation of the coagulum typed by the test of the coagulase, didn't constitute a sufficient discriminating factor in the medical following and the treatment of infections caused by S. aureus.

Aim: To report the clinical, paraclinical and therapeutic aspects of peritonitis from liver abscess and to study the risk factors of rupture

Material and method: From January 2000 to March 2007, we retrospectively studied 5 cases of peritonitis secondary to ruptured of liver abscess at the surgery department of the University Teaching Hospital Le Dantec. These cases were selected among 48 cases of liver abscess managed during the same period.

Results: There were four men and one woman. The mean age was 40.5 years. In 4 cases the Peritonitis was generalised and it was localised in one case. Percutaneous needle aspiration was already performed in 2 cases in a medical department. The abscesses were located in the right hepatic lobe in 3 cases and in left hepatic lobe in 2 cases. The mean diameter of the collection was 10.6 cm with extreme of 8 cm and 15 cm. The right liver abscesses were larger than the left ones (12.3 cm versus 8 cm). There were 2 cases of amoebic liver abscess and 3 cases of pyogenic liver abscess. All our patients underwent resuscitation prior and after the surgical treatment which consisted of abscess evacuation, peritoneal lavage and drainage. We noticed one case of recurrence successfully treated with antibiotics and percutaneous drainage. No death was recorded.

Conclusion: The big size of the abscess, the superficial location or on left hepatic lobe are risk factors of rupture. It justifies the necessity of instrumental evacuation of large hepatic abscess. Surgical drainage offer better results than other modalities in management of ruptured liver abscess.

Introduction: The goal of this study is to access the surgical management of the prostate cancer.

Patients and methods: It was a retrospective study including 96 cases of prostate cancer between June 2002 and December 2004. Parameters studied for every patient was: age, the complaints, results of rectal digital examination, the initial TPSA rate, gleason score, results of extension, the clinical grade according to TNM 2002 classification, the treatment and the future of treated patients.

Results: The mean age of our patients was 70.9 years with extremes of 50 years and 93 years. The complaints at presentation were dominated by prostatism (43.5%) and urine retention (37.7%). At rectal digital examination, the prostate was suspicious of cancer in 42.7%. The majority of our patients (79.8%) had a TPSA rate superior to 20 ng/ml. The examination revealed that the tumour was an adenocarcinoma in all patients. The majority of our patients (50.3%) had a gleason score inferior to 7. The extension outcome revealed: a loco-regional extension in 63 patients, dorso-lombar bone metastases in 19 patients and absence of secondary localisation in 14 patients. The repartition of patients according TNM classification was as following: T1 (1%), T2 (14.6%), T3 (18.8%) and T4 (65.6%). The patients were managed as following: bladder neck resection (surgically or endoscopically), pulpectomy and radical prostatectomy.

Conclusion: To ameliorate the prostate cancer management, the highlights of radical prostatectomy is imperative as the spreading of endoscopic surgery in the place of opening surgery.

Strokes (AVC) represent the 1st cause of death in the department of neurology of Dakar. The main characteristic of stroke is the brutality of the method of formation of neurological deficit. The vascular territory in question amends the clinical expression. Besides the motor deficit stroke can cause neuropsychological disorders affecting language, memory, activity gesture, recognition of oneself and its environment, space and extra corporeal body with the result intellectual deterioration. The mechanisms of stroke are dominated by atherosclerosis and embolic heart disease for ischemic stroke and hypertension and ruptures of vascular malformations for hemorrhagic stroke. CT scan remains the key consideration in determining the nature ischemic or hemorrhagic stroke. Because of its acuteness and rapid progress to irreversible injury stroke is a dramatically high priority medical emergency. The therapeutic strategy should follow a pattern efficient and fast leading to a specific care, gradual and coordinated by the 3rd hour. There is a need to recognize stroke, what is the nature (ischemic, hemorrhagic) and the cause, in order to consider a therapeutic care consistent. The care must start at the very beginning of the stroke and continued during transportation. In the acute phase of stroke, lower blood pressure should be gradual and it is recommended to respect an HTA in the order of 180/105 mm HG except under certain conditions (acute lung oedema, aortic dissection, infarction acute myocardial) that requires a rapid stabilization of blood pressure. Thrombolysis using alteplase (rt-PA) is called in neurovasalar units in case of stroke seen before the 3rd hour and in the absence of contraindications. Anticoagulants are shown in prevention of recurrence of stroke in the embolic heart disease with high risk of recidivism, in the carotid stenosis or vertebral basilar tight with hemodynamic impact downstream and in the extensive thrombosis. The treatment antiplatelet medication is indicated in other cases. The screening and the control of risk factors for vascular constitute an effective weapon for primary prevention. The rehabilitation motor, speech and language and occupational therapy can improve rehabilitation for patients. The prognosis vital and functional depend partly in the early and appropriate management of stroke and also in increasing of education and awareness of population and health care personnel and especially on the diffusion of the means of prevention primary

Introduction: Post-operative Peritonitis (PPO) put some diagnostic and therapeutic problems to surgeons. The aim of the study was: first, to analyze the epidemiological, diagnostic, and therapeutic factors of post-operative peritonitis; then, to define a strategy to improve their prognosis.

Material and method: We did a retrospective study carried out at department of general surgery of the Aristide Le Dantec hospital from January 2001 to March 2007 on cases of PPO. Fifteen cases were included. It was about 12 men and 3 women of middle age of 38.2 years with extremes of 17 and 70 years.

Results: Clinical signs were dominated by the abdominal pain (73.3%) and the fever (66.7%). Abdominal collections were multi-microbial. The digestive suture failure was the dominant reason. All patients have been managed in the 48 hours that followed the diagnosis of PPO. The treatment consisted, essentialy in temporary digestive derivation, washing and drainage of the abdominal cavity framed by an adequate resuscitation. The recovery was 67.7%. Morbidity rate is 33.3%. Mortality concerned 5 patient (33.3%) especially carriers of 2 or 3 visceral failings. Criteria of precocious re-laparotomy have been specified.

Conclusion: The improvement of the prognosis passes indeed by a precocious diagnosis and a coherent multidisci lina a roach.

Introduction: Recent studies have shown that it was possible for subjects with masticatory deficiency chewing achieve a satisfactory level of fragmentation of food by acting on some physiological parameters as the number of cycles and the time devoted to a sequence of mastication.

Method: The objective of this work is to study the effects of the wearing of complete prostheses, of ageing on the physiological parameters from the chewing on a population of 110 subjects.

Results: The results show an important effect of the dental status. Indeed denture weaers need twice more cycles than controls of the same age to make a ham portion ready to be swallowed. Significant an age effect with regard to the number of cycles was also noted. The rheology of food affects the number of cycles which increases with the hardness of food.

Introduction: The objective of this study is to evaluate in under developed country where post operative pain management inadequate the efficiency of the prevention of this acute tolerance with opioids by the ketamine.

Materials and methods: We did a prospective study on months period (January 2004 to June 2004). The setting was the HPD surgical unit recovery room. The patients of more than 15 years and less than 60 years who underwent painful or fairly painful surgical operation under general anaesthesia were included. The patients intubés,ventilated and sedated in the recovery room were excluded from the study .The patients were divided into two groups: in group 1 the patients were given 100 microg/kg of ketamine 15 mn before induction. In group 2 the patients where given a placebo 15 mn before induction. The fentanyl was used systematically during induction at the dosage of 5 microg/kg. The quality of per-operative analgesia was evaluated by the appreciation of the heart rate and the blood pressure. The DPO was evaluated by the analogical visual scale (EV A) at the entrance and the exit of the recovery room, and at the 4th, 8th, 12th and 24th hour after the surgery.

Results: Hundred and thirteen (113) patient were included in the study (groupel with ketamine: 56 patients, groupe 2 without ketamine: 57). The average age was 30 years with extremes from 16 to 60 years. In group 1 and preoperatively 5.9% of the patients receided additional fentanyl ranging from 50 to 100 microg/kg against 47.7% in group 2. In the post-operative period, the morphine consumption was 22.02% for the Group 1 and 43.37% for Group 2. The difference between the two groups is statistically significant. A case of restlessness was noted in group 1.

Conclusion: The low dose ketamine seems to be effective for the prevention of the postoperative severe pain induced by the fentanyl. It allows also an improvement of the quality of per-operational analgesia.