[Botryoid rhabdomyosarcoma of the urogenital sinus. Apropos of 1 case in an 11 month old child]. / Les rhabdomyosarcomes botryoïdes du sinus urogénital. A propos d'un cas chez un enfant de 11 mois.

Rhabdomyosarcomas are the most common sarcomas of the soft tissues found in children under 15 years. The reported observation is of a vaginal tumour having developed in an eleven-month-year-old little girl. It was a typical botryoid rhabdomyosarcoma, usually found in the hollow organs surrounded on the edges by mucus. Rhabdomyosarcomas have many characteristics which vary greatly according to the degree of their cellular differenciation. The majority of these tumours can be classified into four histological categories: embryonic, botryoid, alveolar or plemorphous. The treatment is exeresis surgery with radio- and chemotherapy. Prognosis, however, remains dim despite the therapeutic advances of the last few years.

[Hollow femoral trochlea and femoro-patellar osteoarthritis]. / Trochlée fémorale creuse et arthrose fémoro-patellaire.

INTRODUCTION: The high frequency of femoro-patellar syndrome encountered in Libreville (Gabon) and its association with shallow trochlea and important cartilaginous lesions in our surgical cases urged us to investigate the role of this dysplasia as a cause of femoro-patellar osteoarthritis. MATERIAL AND METHODS: Our study consisted of two series: a retrospective study: 50 patients operated for complications of femoro-patellar syndrome. a prospective study: we analysed the trochlea morphology of 100 healthy Gabonese. RESULTS: In our operated cases, we noted a high frequency of shallow trochlea (61 per cent) with important cartilaginous lesions (64 per cent of femoro-patellar osteoarthritis). In the prospective study, we noted 89 per cent of shallow trochlea. The average trochlea angle was 126 degrees. DISCUSSION: The review of the operated patients showed important cartilaginous lesions associated with a "closed angle trochlea", confirming the observations of Buard and coll., and showing that this dysplasia can be a cause of femoro-patellar osteoarthritis. The prospective study found 89 per cent of shallow trochlea, which is higher to that seen in Europe (19 per cent for Buard and Coll.) and may pose the problem of an anatomic predisposition of osteoarthritis in the Central African patients. CONCLUSION: The shallow trochlea is a dysplasia often encountered in Central Africa. It is associated with important cartilaginous lesions. The shallow trochlea seems to be a favourable factor to femoro-patellar osteoarthritis.

[Is there a place for surgery in Pott's disease in adults? Our experience in Gabon]. / Reste-t-il une place pour la chirurgie dans le mal de Pott de l'adulte? Notre expérience au Gabon.

Tuberculous spondylitis treatment in developing nations remains controversial. We report our experience, working in a Center where appropriate medical and human structures are available. 22 of 78 adults treated at Jeanne-Ebori Hospital (Gabon), for tuberculous spondylitis, between August 1982 and June 1992, underwent surgery. The average age was 48 years (range, twenty-six to sixty-eight years). Eighteen patients had neurological complications: progressive spinal cord lesions: 15 cases (tetraplegia: 3, paraplegia: 11, tetraparesis: 1) and radicular syndromes (3 cases). The patients were seen in advanced stages of the disease with bone destruction, associated with collapse of vertebrae in ten cases. Indications for surgery were: neurologic in eleven cases, mechanical in one case, and mixed in ten cases (neurologic and mechanical: 5, etiologic and mechanical: 3, etiologic and neurologic: 2). Anterior approach were performed in 10 cases, posterior approach in 12 cases, generally, following an initial three weeks course of antituberculous therapy. The average length of time spent in hospital including rehabilitation had been 10.4 weeks. The average follow-up was 23.7 months (range: 8 months to 8 years). All patients obtained fusion, and stability was achieved after 3-5 months. The neurological recovery was complete in 9 cases, partial in 8 cases, unchanged in one case. All patients were considered medically cured. The analysis of material and socio economic difficulties obliges us to reduce the treatment length by favoring surgical intervention in relatively advanced lesions. Moreover, that allows to specify the diagnosis.

Diagnostic et traitement des lesions traumatiques instables du rachis cervical inferieur sans complication neurologique au Gabon

23 lesions traumatiques instables du rachis cervical inferieur (C3-C7) sans signe de deficit neurologique ont ete traites sur une periode de 8 ans. Le traitement a ete conservateur (6 cas) ou chirurgical (5 cas); 2 patients sont decedes sous traction cranienne avant le traitement definitif. Une fois; des complications neurologiques transitoires sont survenues en post-operatoire immediat. Une re-intervention a ete necessaire dans un cas. Dans l'ensemble; on a observe une consolidation osteoligamentaire satisfaisante. La discussion porte sur l'importance du bilan radiologique et les indications operatoires

[Unstable traumatic lesions of the lower cervical spine without neurologic deficiency. Our experience at the Fondation Jeanne Ebori in Libreville (Gabon)]. / Lésions traumatiques instables du rachis cervical inférieur sans signe de déficit neurologique. Notre expérience à la Fondation Jeanne Ebori de Libreville (Gabon).

23 cases of unstable traumatic lesions of the lower cervical spine, without neurologic complication, were treated over a period of eight years. These cases consisted of eight dislocations, five subluxations, nine fracture-dislocations and one "tear drop" or fracture of the vertebral body. Six cases were treated conservatively and fifteen operatively. Two patients died in skeletal traction while awaiting surgical intervention. The surgical approaches were anterior (6 cases), posterior (8 cases) and combined (1 case). There was one case of transitory neurologic deficit immediately after surgery. One case required re-intervention. Overall they obtained satisfactory osteoligamentary consolidation.

[Surgical treatment of lumbar spinal stenosis in Gabon]. / Traitement chirurgical des canaux lombaires étroits au Gabon.

The authors report their experiences based on 41 cases operated on for lumbar spinal stenosis between 1981 and 1988. The series included 28 men and 13 women aged between 23 and 63 years (mean age: 48 years). Neurogenic intermittent claudication was the presenting symptom in only 12% of the cases, as opposed to lumbago-sciatica in 78%. Clinical examination did not provide any specific elements. The key to diagnosis was lumbar myelography. Laminectomy was the most important aspect of treatment which, in certain cases, was associated with vertebral stabilization by arthrodesis (3 cases). There were ten minor operative complications. Further surgery was necessary in five cases (12%). Therapeutic results in patients followed from one to eight years (35 cases) were satisfactory. The discussion covers nosologic, clinicoradiologic and therapeutic aspects.

[The value of anterior plate fixation without bone graft in simple luxation and various fracture-luxations of the lower cervical spine]. / Intérêt de l'ostéosynthèse antérieure par plaque vissée sans greffe intersomatique dans les luxations simples et certaines fractures-luxations du rachis cervical inférieur.

In comparison to posterior fixation by Roy-Camille plates which does not require bone grafting, the authors present 9 cases of anterior plate fixation, also without bone grafting (6 dislocations and 3 fracture-dislocations of the lower cervical spine). The results and indications of this technique are discussed.