Impact of the Intra- and Inter-observer Variability in the Delineation of Parotid Glands on the Dose Calculation During Head and Neck Helical Tomotherapy.

The intra- and inter-observer variability in delineation of the parotids on the kilo-voltage computed tomography (kVCT) and mega-voltage computed tomography (MVCT) were examined to establish their impact on the dose calculation during adaptive head and neck helical tomotherapy (HT). Three observers delineated left and right parotids for ten randomly selected patients with oropharynx cancer treated on HT. The pre-treatment kVCT and the MVCT from the first fraction of irradiation were selected to delineation. The delineation procedure was repeated three times by each observer. The parotids were delineated according to the institutional protocol. The analyses included intra-observer reproducibility and inter-structure, -observer and -modality variability of the volume and dose. The differences between the left and right parotid outlines were not statistically significant (p > 0.3). The reproducibility of the delineation was confirmed for each observer on the kVCT (p > 0.2) and on the MVCT (p > 0.1). The inter-observer variability of the outlines was significant (p < 0.001) as well as the inter-modality variability (p < 0.006). The parotids delineated on the MVCT were 10% smaller than on the kVCT. The inter-observer variability of the parotids delineation did not affect the average dose (p = 0.096 on the kVCT and p = 0.176 on the MVCT). The dose calculated on the MVCT was higher by 3.3% than dose from the kVCT (p = 0.009). Usage of the institutional protocols for the parotids delineation reduces intra-observer variability and increases reproducibility of the outlines. These protocols do not eliminate delineation differences between the observers, but these differences are not clinically significant and do not affect average doses in the parotids. The volumes of the parotids delineated on the MVCT are smaller than on the kVCT, which affects the differences in the calculated doses.

[Hematemesis in Togo: findings of a 12-month study in an intensive care unit]. / Hématémèses au Togo: expérience d'un an en réanimation.

This prospective study was conducted over a 12-month period on patients who underwent upper digestive endoscopy for hematemesis in the medical intensive care unit (ICU) of the Tokoin University Hospital Center in Lomé, Togo. A total of 44 patients with a mean age of 44 years were included. The sex-ratio was 2.61. Risk factors included use of non-steroid anti-inflammatory (NSAI) in 16 patients (36.4%) and alcohol abuse in 13 (29.6%). At the time of admission to the ICU, 21 patients (47.7%) were in hemodynamic shock and 11 (25%) presented signs of portal hypertension. The underlying etiology was peptic ulcer in 18 cases (40.9%) including 13 cases of duodenal ulcer and 5 cases of stomach ulcer, rupture of esophageal varicosities in 8 (18.2%), gastric tumor in 6 (13.6%), Mallory Weiss syndrome in 5 (11.4%), gastritis in 4 (9,1%), and esophagitis in 3 (6.8%) due to peptic inflammation in 2 and mycotic infection in 1. The mortality rate was 45.5%. The main causes of hematemesis were peptic ulcer and rupture of esophageal varicosities. The death rate was high due to inadequate care facilities.

[Upper digestive tract endoscopy in rural Africa: Togo]. / Endoscopie digestive haute en milieu rural africain au Togo.

The purpose of this report was to describe the profile of esogastroduodenal disease diagnosed by upper digestive tract endoscopy (UDTE) in a rural area of Togo. This prospective study combines data collected during two two-week screening campaigns carried out in the Kara region. Patients were informed of the presence of the endoscopy team by means of a bulletin on a rural radio station. All male and female patients 15 years or older were included. A total of 220 UDTE procedure reports were recorded and analyzed including 107 men and 113 women with a mean age of 37.7 years (range: 15-84 years). Disease was detected in 72 procedures mainly in the 21 to 41 year age group (47.2 %) with a higher proportion of men than women: 38% versus 27% respectively. The most frequent indications for UDTE were epigastralgia (47.7 %) including 39% of procedures leading to the discovery of disease and diffuse abdominal pain (21.8 %). The procedure was carried out for follow-up purposes in 19.1% of cases. The most common lesions were peptic ulcer (34.2%), inflammatory disease including esophagitis, gastritis, and bulboduodenitis (32.4%), gastroduodenal bile reflux (9.3%), pylorobulbar stenosis (5.5%), tumoral disease (3.7%), and esophageal varicosities (3.7%). This study based on UDTE diagnostic procedures provided insight into the profile of esogastroduodenal disease in rural Africa. These screening campaigns required special organization using appropriate equipment and personnel.

[Aetiologics aspects of proctorrhagia at the black adult African: about 85 cases collect in 12 years in CHU-Campus of Lome]. / Aspects etiologiques des rectorragies chez l'adulte en milieu Africain: a propos de 85 cas colliges en 12 ans au CHU-Campus de Lome.

PURPOSE: To count the aetiology of proctorrhagia in Lomé. METHODS: It is a retrospective study, over 12 years (1st January 1995-31 December 2006), realised from the reports of the coloscopy . It included the patients of the two sexes, old of more than 15 years, having presented a proctorrhagia explored by ano-rectoscopy and coloscopy. RESULTS: The proctorrhagia represent 38.72% of the indications of the coloscopy. The patients from 24 to 45 years were reached (52.94%). A male prevalence was found (sex-ratio: 2.4). Among the aetiology found, the haemorrhoids more frequent (23.53%), were followed by the non specific colitis (16.47%), the ulcero- haemorrhage rectocolitis (15.29%), the colon diverticulosis (10.58%), the amoebic colitis (9.4%) and colorectal cancer (5.88%). The hemorroid were associated with a non specific colitis (1 case), a ulcero-hemorrhagic rectocolitis (1 case), an amoebic colitis (1 case) and diverticulose colic (1 case). In 12 cases (14.12%), no aetiology was found. CONCLUSION: The haemorrhoids represent the most frequent aetiology of the proctorrhagia in Lomé; however their discovery in ano-rectoscopy should not exempt realisation of a complete coloscopy in the search of other causes.

Aspects etiologiques des rectorragies chez l'adulte en milieu africain : a propos de 85 cas colliges en 12 ans au CHU - campus de Lome

But : recenser les etiologies des rectorragies au CHU-Campus de Lome. Methodologie : Il s'agit d'une etude retrospective sur 12 ans (1er janvier 1995 - 31 decembre 2006); realisee a partir des comptes-rendus de coloscopie. Elle a inclus les dossiers des malades des deux sexes; ages de plus de 15 ans; ayant presente une rectorragie exploree par une ano-rectoscopie et une coloscopie totale. Resultats : les rectorragies representent 38;72des indications de la coloscopie. Les malades ages de 24 a 45 ans ont ete les plus atteints (52;94). Une predominance masculine a ete retrouvee (sex-ratio : 2;4). Parmi les etiologies retrouvees; les hemorroides ont ete plus frequentes (23;53) suivies par les colites non specifiques (16;47); la recto-colite ulcero-hemorragique (15;29); la diverticulose colique (10;58); les colites amibiennes (9;4) et le cancer colorectal (5;88). Les hemorroides etaient associees a une colite non specifique (1 cas); a une recto-colite ulcerohemorragique (1 cas); a une colite amibienne (1 cas) et a une diverticulose colique (1 cas). Dans 12 cas (14;12); aucune etiologie n'a ete retrouvee. Conclusion : Les hemorroides representent l'etiologie la plus frequente des rectorragies a Lome; cependant leur decouverte a l'ano-rectoscopie ne doit pas dispenser de la realisation d'une coloscopie complete a la recherche de lesions associees

Prise en charge des urgences en gastro-enterologie : experience du service d'hepato-gastro enterologie du CHU-campus de Lome

But : Recenser les urgences rencontrees; leur diagnostics etiologiques et evaluer l'efficacite des approches therapeutiques. Methodologie : c'est une etude retrospective sur 1 an; de janvier a decembre 2004; sur les dossiers de malades admis pour urgences dans le service. Resultats : 65 dossiers de malades (49 hommes et 16 femmes) ages de 20 a 79 ans ont ete retenus. Le type de l'urgence rencontre a ete : hemorragie digestive (44 cas) dont 25 cas d'hemorragie digestive haute (HDH) et 19 cas de rectorragie ; douleur abdominale avec vomissement : 19 cas dont 4 malades avec arret des matieres et des gaz ; l'ingestion accidentelle de caustique : 2 cas. A l'admission un tableau de choc a ete retrouve chez 15 malades (5 en coma stade I ) qui ont d'emblee ete reanimes.11 malades ont ete transferes en chirurgie. Les etiologies des HDH ont ete dominees par les ulceres :16 cas (64) et les ruptures de varices oesophagiennes (RVO) : 7cas(28) ; celles des rectorragies par la rectocolite hemorragique ( RCH) : 8 cas (42;10) . Les etiologies des douleurs abdominales etaient tres diverses dominees par les occlusions; les gastrites; les ulceres gastro-duodenaux; les cancers du pancreas avec 4 cas (22;22) chacun. L'evolution clinique a ete marquee par 7 deces dont 6 par RVO . Conclusion : les urgences en gastro-enterologie sont frequentes dans le service d'HGE du CHUCampus de Lome (65 cas en 1 an). Elles sont dominees par les hemorragies digestives .Leur etiologie est souvent retrouve (98;45) par nos moyens d'exploration limites mais elles posent surtout un probleme de prise en charge therapeutique notamment les RVO dont la mortalite est tres elevee (85;71) en raison du manque de ressources therapeutiques endoscopiques (ligature; sclerotherapie) et medicamenteuses (molecules reduisant le debit splanchnique)

Endoscopie digestive haute en milieu rural africain au Togo

Objectifs : determiner le profil des pathologies oesogastroduodenales diagnostiquees par endoscopie oesogastroduodenale (EOGD) enmilieu rural au Togo. Methode : Il s'agit d'une etude prospective regroupant deux campagnes d'EOGD de deux semaines chacune. Les malades informes de la presence de l'equipe par radio rurale ont ete recrutes dans la population generale de la region de la Kara. Tous les patients des deux sexes ages de 15 ans au moins chez lesquels une EOGD a ete realisee ont ete inclus. Resultats : Deux cent vingt (220) comptes rendus d'EOGD ont ete enregistres et retenus dont 107 hommes et 113 femmes. Leur age moyen est 37;7 ans (extremes : 15-84 ans). Soixante douze EOGD se sont revelees pathologiques plus frequemment dans la tranche d'age de 21 a 40 ans (47;2) ainsi que chez les hommes (38) contre 27chez les femmes. L'epigastralgie (47;7) represente l'indication la plus frequente d'EOGD dont 39sont pathologiques; suivies des douleurs abdominales diffuses (21;8).Dans 19 ;1cas; il s'agit d'un controle. Les lesions les plus retrouvees sont l'ulcere gastroduodenal (34;2) suivi respectivement des pathologies inflammatoires (oesophagite; gastrite; bulboduodenite) avec 32;4; des reflux biliaires duodeno-gastriques (9;3); des stenoses pylorobulbaires (5;5); de la pathologie tumorale (3;7) et des varices oesophagiennes (3;7). Conclusion : Ce travail nous a permis grace a l'EOGD de degager le panorama de la pathologie oesogastroduodenale en milieu rural africain. Ces campagnes ont necessite une organisation originale qui repose sur un equipement et un personnel adequat