Profil épidémiologique des traumatismes crânio-encéphaliques au Centre Hospitalier et Universitaire de Bouaké

Introduction : Les traumatismes crânio-encéphaliques représentent une des principales causes de mortalité dans le monde. L'étude de leur épidémiologie permet d'identifier les facteurs de risque pour mieux cibler les actions de prévention. Patients et méthodes : Il s'agissait d'une étude rétrospective descriptive réalisée au service de réanimation polyvalente du CHU de Bouaké de janvier 2013 à décembre 2014. Elle concernait les patients admis en réanimation pour un traumatisme crânio-encéphalique avec un score de Glasgow inférieur à 14. Les paramètres étudiés étaient : le sexe, l'âge, la profession, les circonstances de survenue les modalités de transport, le délai d'admission à l'hôpital et la durée d'hospitalisation. Résultats : Au total 1244 patients ont été hospitalisés durant la période d'étude, dont 92 pour un traumatisme crânio-encéphalique, soit une prévalence hospitalière de 7,39%. Il y avait 86 hommes et 6 femmes. L'âge moyen était de 32,6 ans ± 17,03 (extrêmes 2 à 76 ans). Les conducteurs de mototaxi et les élèves étaient concernés dans respectivement 49% et 24% des cas. Les étiologies étaient dominées par les accidents de la voie publique (87%) qui impliquaient les engins à deux roues motorisés dans 40% des cas. Le transfert des patients a été effectuée par le groupement des sapeurs-pompiers militaires dans 48,9% des cas. L'admission des patients s'est faite dans 61% des cas avant la 6e heure suivant le traumatisme et le délai moyen d'admission était de 3 heures. La durée moyenne de séjour était de 4,37 ± 4,23 jours (extrêmes 1 à 21 jours). La mortalité globale était de 66%. Conclusion : Les traumatismes crânio-encéphaliques sont fréquents à Bouaké et font suite à un accident de la voie publique impliquant un engin motorisé à deux roues dans la majorité des cas. La prévention repose sur la sensibilisation au respect du code de la route

Is postoperative radiotherapy beneficial in the management of stage I-II squamous-cell carcinoma of the uterine cervix with negative metastatic nodes and positive parametrial involvement?: A retrospective review of 70 patients.

Seventy patients having squamous-cell carcinoma of the uterine cervix FIGO Stage I-II with negative lymph nodes and positive parametrial involvement received postoperative radiotherapy following radical hysterectomy and pelvic lymphadenectomy. In 48 patients with microscopic parametrial invasion, the 5-year survival rate was 92%. The other 22 patients with macroscopic parametrial involvement had a 5-year survival rate of 75%. The overall recurrence rate was 13% (9 of 70). The sites of failure were 3 pelvic alone, 5 distant metastases alone, and 1 combined pelvis and para-aortic lymph node. All of those with recurrence were Stage-II cases. The absolute pelvic-control rate was 94.3% (66/70). Fifty-six percent of the patients experienced mild-to-moderate lymphedema. Severe complications requiring surgical intervention were observed in 6 patients (5 bowel obstructions and 1 femoral head fracture). A review of the literature suggests that early carcinoma can be successfully treated by surgery alone. Taking into consideration the risk and benefits involved, postoperative radiotherapy is not recommended for most cases with cervical carcinoma with negative lymph nodes and positive parametrial involvement in the present form, despite excellent local control. However, no definite conclusion can be drawn from this retrospective analysis.

Analysis of adenoid cystic carcinoma treated by radiotherapy.

The records of 41 patients with adenoid cystic carcinoma of the head and neck region who had been treated with radiotherapy were reviewed. Local control was achieved in 72.3% in the cases with primary lesions at 5 years. The prognosis for tumors that arose in the major salivary glands was better than that for tumors that arose in the minor salivary glands; however, the difference was not statistically significant. In the minor salivary glands, early-stage tumors were well controlled with the use of radiation therapy alone. In spite of the high local control rate, the disease-free survival rate of the patients at 10 years was only 20.8%. Lung metastasis determined the prognosis.

Alveolar hydatid disease of the liver: computed tomography and transabdominal ultrasound with histopathological correlation.

The appearances of alveolar hydatid disease of the liver (AHDL) on computed tomography (CT) and ultrasound (US) were retrospectively compared with histopathological appearances in 67 patients with 100 separate lesions. The radiological features were correlated directly with the pathological specimens obtained from each patient. We conclude that the CT appearances are more specific, but that US has a role to play in mass screening in endemic areas, and intraoperatively.

User requirements and standards for PACS. 2nd Japan-Nordic PACS Symposium.

PACS has been regarded as a system which will bring a new era to image handling, radiology departments and its services to other departments of the hospital. However, many recently held international conferences indicate that a worldwide consensus on 'what is PACS, why is PACS needed and who is PACS for' has not been established. Although the actual PACS implementation will vary among the countries and according to each situation, a worldwide consensus of PACS should be possible. This would help those involved to speed up the implementation of PACS. It is suggested that this consensus needs to be developed by convergence of three points of view; the availability, maturity and cost of the technologies on which PACS is built, the user requirements for PACS and standardization in PACS. These themes were the topics of the 2nd Japan-Nordic PACS Symposium which was arranged in Tampere, Finland, June 9-11th 1991. A summary of the papers and discussions of the symposium is produced in this paper.

Feasibility of PACS based on 2 years experiences of Hokkaido University PACS.

Some features of HU-PACS which is now just 2 years old are described with the results of clinical assessment on it. It is clear that many advancements in technology have made the HU-PACS to be a useful tool of clinical routines. The paper describes also problems of the system in future with general comments on technology assessment and cost benefit issues.

[MR imaging of hilar cholangiocarcinoma--comparative study with CT].

Magnetic resonance (MR) images of 18 cases of hilar cholangiocarcinoma were evaluated to compare the effectiveness of Gd-DTPA with that of high dose contrast enhancement computed tomography (HCE-CT) in detecting the primary tumor. The primary tumor was demonstrated as having slightly low intensity compared with liver parenchyma and high intensity compared with the dilated bile duct on T1 weighted images. In contrast, MRI using Gd-DTPA, which was carried out in five cases, revealed intense enhancement of the tumor. As the differentiation between cholangiocarcinoma and dilated bile duct was difficult, it was concluded that the use of Gd-DTPA improves the efficacy of MRI in diagnosing cholangiocarcinoma. Gd-DTPA was also effective in differentiating the growth pattern of the tumor: the infiltrating type was demonstrated as thickening of the wall of the bile duct, the polypoid type as a soft tissue mass in the bile duct. Contrast MRI study is effective for the detection of cholangiocarcinoma. It is also expected to be effective in the staging diagnosis of cholangiocarcinoma.

Concept of Hokkaido University picture archiving communication system.

The basic concept of Hokkaido University picture archiving communication system (HU-PACS) for its design in hardware architecture and in its characteristic functions is reported. After almost 10 years, the concept was solidified as the opinion of most of the doctors of HU Hospital. Discussions with vendors were very helpful in providing technical or industrial expertise and equipment to effect this concept with the limited funds available.

Telephone line transfer using a local filing system in Hokkaido.

An image-data transfer system using a public telephone line has been constructed between Hokkaido University Hospital (HUH) and Nakashibetsu Town Hospital (NTH). The latter is situated about 420 km from Sapporo and does not have full-time radiologists. A local filing system coupled with a film reader and an optical disk had been installed in HUH in 1986, and in NTH in 1988. Both systems were connected by a public telephone line along which the transfer speed is 9600 bps. Images originating at NTH, mostly CT, were digitized by the film reader and sent to HUH after compression at a ratio of about 5:1 to 10:1. Clinical information concerning a patient was also sent to HUH using facsimile. Radiologists interpreted the transferred data (12 CT images on a film) on the CRT and sent back a written report to NTH using facsimile. The system and its image quality are largely acceptable, especially in an emergency case for brain and abdomen, although the transfer of a film takes about 7 to 20 min.

HU-PACS. 10 months experience.

An outline of the Hokkaido University PACS (HU-PACS) and 10 months experience of its clinical use are reported. It is concluded that HU-PACS is a useful clinical tool, even though some points still remain to be improved.

Clinical experience--16 months of HU-PACS.

Sixteen months experience with HU-PACS (Hokkaido University PACS) is reported. This report describes the hardware and software aspects of HU-PACS in its working state. Evaluation of the system is also reported, and usefulness of PACS concludes paper.

[Ultrasonography as a supplemental technique for the diagnosis of adhesion and invasion of abdominal tumors].

Diagnostic capability of ultrasonography (US) concerning with adhesion and/or invasion of the tumors to the surrounding tissues in the abdominal region including pelvis was evaluated in 54 patients with comparison to that of CT. All the lesions reached the surface of the organ and whether the adhesion or invasion of the lesion to the surrounding organ or tissue was a problem. All the patients underwent US and CT. US was performed not only in the usual real-time manner, but with "supplemental" techniques: respiration, drinking water, rectal infusion and bimanual examination. Accuracy of US reached 72% with one or some of those four US supplemental techniques, while accuracy of CT which yields only stable image was 30% (p less than 0.005 by chi 2 test). US with suitable supplemental techniques should be applied to those cases with suspected adhesion or invasion of the tumor in the abdomen, and when CT is not reliable to judge this problem.

[A randomized trial of single and multifraction radiation therapy for bone metastasis: a preliminary report].

From April, 1989 through January, 1990, a randomized trial was conducted to investigate the efficacy of single fraction radiation treatment (8, 10, 12, 15Gy) compared to a multifraction dose schedule (5Gy x 4, 5Gy x 5, 5Gy x 6) as a therapy for a bone metastasis. Both subjective and objective pain scores were used to measure the therapeutic results. A total of 31 patients participated in the trial and, for analysis, 27 of these patients were follow-up for more than 8 weeks after the start of the radiation therapy. The following statistics resulted. Of the single fraction series, symptomatic pain relief was obtained in 86% of the patients (12/14 treatment areas), and of the multifraction series, 92% (12/13). Further, a complete response was achieved in 57% (8/14) of the single fraction patients and 31% (4/13) of the multifraction patients, respectively. Between the two treatment regimens, no difference was found in the incidence of pain relief, speed of onset, or acute morbidity. Finally, no severe morbidity was seen in either arm.

Results of prophylactic adjuvant chemotherapy for early stage non-Hodgkin's lymphoma of the head and neck.

Results were reviewed in 46 patients who had stage I and II head and neck non-Hodgkin's lymphoma, and received five to six cycles of CVP chemotherapy after regional irradiation. Disease-free survival, pattern of relapse, and time of relapse were compared with those of 64 patients, who received regional irradiation alone. Adjuvant, post irradiation CVP significantly improved five-year survival in stage I (and IE) disease, 49.6% to 81.9% (p less than 0.05), but was less successful in patients with heavier tumor burden, such as stage II disease or advanced loco regional disease in Waldeyer's ring (48.3% to 63.7%; p greater than 0.10 in stage II patients). In addition, in those who relapsed, the time and pattern of relapse were not altered by adjuvant CVP chemotherapy. This easily tolerated, mild adjuvant chemotherapy, we conclude, failed to prove significant in preventing relapse, especially in patients with heavier tumor burden.

[Ultrasonography of the extremities: nontumor lesions].

Ultrasonographic imagings of non-tumor disorders in extremities were reviewed and discussed. All cases underwent surgery. In our retrospective evaluation, US was found to be effective in cases of tendon injuries, articular osteochondritis, tenosynovitis and the displacement of chondral navicula in infantile club foot, etc.

[Radiotherapy of carcinoma of the uterine cervix--high dose rate intracavitary irradiation using a linear source arrangement].

We analyzed the records of 339 patients with squamous cell carcinoma of the uterine cervix. The patients were treated by irradiation alone in the period of 1973-1985 with external and high-dose rate intracavitary irradiation using linear source arrangement. The reason for using the linear source arrangement was to ensure the position of source as well as to simplify the technique of intracavitary irradiation. First, external irradiation was performed mainly with a dosage of 50Gy/25f four times a week or 50.4Gy/28f five times a week. Intracavitary irradiation was then carried out mainly with a dose of 30Gy/6f two times a week or 35Gy/7f two times a week and dose was indicated at point A. The 5-year survival rate of all 330 patients were 51.4%, and 55.1% for stage I (N = 19), 66.7% for stage II (N = 88), 47.1% for stage III (N = 212), 33.7% for stage IV (N = 20). Of the patients followed up for 24 months and found to have recurrence, 21.8% (39/179) had a recurrence in the pelvis and 22.1% (39/175) were found to have a distant metastasis. Of the patients followed up for over 24 months, 21.5% 932/149) developed intestinal complications and 12.2% (18/149) developed bladder complications. However complications Grade 2-4 were 5.4% for intestinal complications and 2.0% for bladder complications. From these results high-dose-rate intracavitary irradiation using a linear source arrangement was considered to be an effective treatment of carcinoma of the uterine cervix and to produce a standard results of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of icteric hepatoma with laryngeal metastasis and coexisting pancreatic cancer].

An autopsy case of a hepatocellular carcinoma with an omental mass, a laryngeal metastasis, and a coexisting pancreatic head carcinoma is reported and the diagnostic problems it presented is discussed. An obstructive jaundice was treated by transhepatic drainage, and was proved to be caused by the invasion into the bile duct of the hepatocellular carcinoma and not the pancreatic head tumor. An asymptomatic, papillomatous growth from the metastasis of the hepatocellular carcinoma was found in subglottic region, an extremely rare type of metastasis .

[Cystic papillary carcinoma of the thyroid--sonographic-pathologic correlation].

Ultrasonographic findings of 13 patients with cystic papillary carcinoma (CPC) of the thyroid gland were reviewed retrospectively correlating with pathologic findings. A 4-6 cm oval cystic structure with a 2-3 cm pedunculated projection of mass into the lumen was the characteristic sonographic findings of CPC. However, other sonographic findings of CPC simulated adenoma, nodular goiter or follicular carcinoma. Pathological investigation revealed that malignant cells tended more to be located in intracystic pedunculated mass and/or pericystic region than in the cyst wall. In most of the cases cyst walls were chiefly composed of granulomatous tissue with scattered malignant cells. These findings indicate that the needle biopsy should be done under ultrasonographic guidance to obtain sufficient material for accurate cytologic and/or pathologic diagnosis, thereby reducing the number of false negative cases.