[External Quality Assessment of Thick and Thin Blood Smear Slides for the Diagnosis of Malaria in the Lomé and Gulf Health Districts of Togo]. / Évaluation Externe de la Qualité de la Goutte Épaisse/Frottis Sanguin pour le Diagnostic du Paludisme dans les Districts Sanitaires de Lomé et du Golfe au Togo.

Objective: In sub-Saharan Africa where 90% of malaria cases are concentrated, the control of this disease constitutes a major challenge whose diagnosis by thick and thin smear deserves to be exact and reproducible. The purpose of this study is to assess the performance of thick/thin blood smear in order to improve its implementation process. Material and methods: This was a descriptive and analytical study that took place from May to June 2017 and involved participating laboratories (PL) coming from public, liberal and confessional sectors in Lomé. A set of 13 blood smear slides of variable parasite densities (PD) with assigned values (AV) of parasite densities and the Plasmodium species assigned was used. The criterion for establishing the parasite densities compliance interval was assigned values ± 25% and the performance rates were compared to the 80% recommended by the WHO for Africa region. Results: 41.9% (13/31) of the PLs had a compliance rate greater than 80% including four with a performance of 100% for the ability to identify the Plasmodium species. For the parasitaemia < 100/µl, 51.6% of participating laboratories had a performance rate less than 80% and for parasitaemia > 2000/µl, 100% of these laboratories had a performance rate greater than 80%. Conclusion: The evaluated laboratories had insufficient ability for the identification of Plasmodium falciparum and the correct estimation of low parasitaemia. A need to strength the technical skills, adapted to the context of low parasitaemia are essential to improve the biological diagnosis of malaria in Togo.

Intermediate range structure of amorphous Cu2GeTe3: ab initio molecular dynamics study.

We have investigated the intermediate range structure of amorphous Cu2GeTe3 based on ab initio molecular dynamics simulations. The highest population of ring size is three, which makes the triangle structure. This ring consists of mainly Cu2Te. Rings may also consist of CuCuCu, Cu2Ge, and CuGeTe, where approximately 88% of Cu atoms in the system are related with the three-membered ring. The second highest population of ring size is five. Three- and five-membered rings in the amorphous phase originate from six-membered ring in the crystalline phase. This situation can enhance the phase transition between crystalline and amorphous phases. In the phase change process, Cu atoms may diffuse in the amorphous state with changing bonds. The diffusion coefficient of Cu D Cu is estimated to be approximately 0.12 × 10-9 m2 s-1. Such high diffusion coefficient of Cu atoms is contributed from only 10% of Cu atoms in the amorphous phase.

Microscopically Positive Resection Margins in Laparoscopic Gastric GIST Resection May Not Confer a Poorer Prognosis.

Laparoscopic resection of gastrointestinal stromal tumor (GIST) has increased popularity with studies showing good outcomes for patients with tumors <5 cm, with a shorter hospital stay, lower blood loss, and morbidity. Our study aims to audit the clinical profile and surgical outcomes of GISTs, with an evaluation of laparoscopic versus open surgery and the prognostic role of positive R1 margins. In our retrospective study, 62 GIST patients who underwent surgery were included and further analysis was made for the 48 gastric GISTs patients. In total, 33 patients underwent laparoscopic gastric GIST resection, whereas the rest underwent open resection. There was no difference in operative duration but the blood loss was lesser and length of stay shorter in the laparoscopic group. The laparoscopic group had a higher incidence of R1 resection but none developed recurrence or metastasis during follow-up. Laparoscopic resection in the management of gastric GISTs resulted in higher R1 resection rates but this did not affect recurrence rates or overall survival.

[Epidemiological and clinical aspects of visible urogenital malformations among adolescent's schoolboys at Cotonou]. / Aspects épidémiologiques et cliniques des malformations urogénitales cliniquement visibles chez les élèves adolescents de Cotonou.

AIMS: To detect systematically visible urogenital malformations (VUGM) in adolescents and describe their epidemiological and clinical aspects. PATIENTS AND METHODS: It was a cross sectional, descriptive and analytical study, conducted from February to August 2012. Upon 2724 adolescents from 10 to 19 years old, of the public secondary schools of Cotonou. Among the 26,594 registered pupils, 2724 were included and examined after a randomized sampling of 30 clusters. RESULTS: The mean age of the pupils was of 15 ± 2.30 years (11-19 years), with a peak at 18 years. The prevalence of the VUGM was slightly higher (9.57%) in individuals those had parents with low socioeconomic level. The prevalence of the VUGM was high in Yoruba and related (P=0.02). It was stronger (9.84%) among subjects in puberty period's than in pre-puberty (6.69%) (P=0.03). From the 253 having VUGM, 78 (30.83%) had 146 functional signs. It was indexed 266 affections and of malformatives associations in 21 pupils (8.30%). Varicocele was the most frequent (5.47%), followed by inguinal hernia (0.99%), hydrocele (0.88%), anomalies of testis migration (0.59%), cyst of spermatic cord (0.51%), insulated testicular hypotrophy (0.48%), micro-penile (0.33%), hypospadias (0.22%), penile curvature (0.22%) and epididymis cyst (0.07%). CONCLUSION: Among patients who had VUGM, the majority had at least a varicocele, which occupies so far the first place within these malformations at the adolescents in Cotonou.

Urethral mucosal prolapse in young girls: a report of nine cases in Cotonou.

BACKGROUND: Urethral mucosal prolapse is rare. This condition may be confused with tumour or sexual abuse in girls. This study aims at reporting the pathology presentation and therapeutic options of urethral prolapse in girls. MATERIALS AND METHODS: A retrospective study was undertaken from January 2000 to December 2008. Authors analysed the clinical features and the treatment options. RESULTS: There were nine cases of urethral prolapse. The ages ranged from 2.5 to 10 years (mean age: 5.08 years). The main presentation was vaginal bleeding (five cases). Physical examination revealed a soft, non-tender mass that bleeds on touch (six cases), with a length ranging from 0.75 to 1 cm. Urine culture in four patients revealed urinary infection that yielded Escherichia coli in three cases and the Staphylococcus aureus in one case. Six patients had surgical treatment while three had medical treatment. In those who had surgery, one had acute urine retention and one had recurrence that was treated successfully without operation. All the nine girls are cured. CONCLUSION: Urethral prolapse is a disease of the prepubertal girls of low socio-economic group. Diagnosis is clinical. The treatment of choice is surgical.

Urethral mucosal prolapse in young girls: a report of nine cases in Cotonou

Background: Urethral mucosal prolapse is rare. This condition may be confused with tumour or sexual abuse in girls. This study aims at reporting the pathology presentation and therapeutic options of urethral prolapse in girls. Materials and Methods: A retrospective study was undertaken from January 2000 to December 2008. Authors analysed the clinical features and the treatment options. Results: There were nine cases of urethral prolapse. The ages ranged from 2.5 to 10 years (mean age: 5.08 years). The main presentation was vaginal bleeding (five cases). Physical examination revealed a soft; non-tender mass that bleeds on touch (six cases); with a length ranging from 0.75 to 1 cm. Urine culture in four patients revealed urinary infection that yielded Escherichia coli in three cases and the Staphylococcus aureus in one case. Six patients had surgical treatment while three had medical treatment. In those who had surgery; one had acute urine retention and one had recurrence that was treated successfully without operation. All the nine girls are cured. Conclusion: Urethral prolapse is a disease of the prepubertal girls of low socio-economic group. Diagnosis is clinical. The treatment of choice is surgical

Femoral bifurcation associated with tibial aplasia: about 3 cases.

Femoral bifurcation associated with tibial aplasia of the limb is a very rare pathology. Its radical treatment is a disarticulation of the knee, followed by fitting of a prosthesis. In Benin the reluctance of parents to allow their children to undergo amputation and the access to equipment for the amputated child are a major technical and financial hindrance. Here we report three cases.

[Situation and perspectives of blood transfusion in Togo]. / Situation actuelle et perspectives de la transfusion sanguine au Togo.

We report the successive stages of the reorganization of the blood transfusion sector in Togo. The starting point was the elaboration of the national policy of blood transfusion, then the adoption of a decree organizing the sector as well the various decree of application, particularly that related to transfusion good practices. The current policy recommends two poles of qualification of the blood ant its components and the creation of six stations of collection and distribution attached to these poles. The reorganization started with the rehabilitation of the National Blood Transfusion Centre (CNTS) in Lomé. If the problem of human resources is alarming, especially the availability of hemobiologists, the rehabilitation allowed the increase of the blood collection passing from 5272 donations in December 2003 to 18 164 in December 2008. However, the requirement of blood products is satisfied in 50% in all the country. In 2003, 24% of the blood products were rejected for positive viral markers against 8.37% in 2008 in relation with the improvement of blood safety. Efforts must be continued to reinforce it in the CNTS and to make a better selection of the donors at the Regional Blood Transfusion Centre (CRTS) de Sokodé. The analysis of the weak points of the sector (human resource insufficiency, shortage of the blood products, blood safety) made it possible to indicate solutions to improve the sector of blood transfusion sector. Future outcome is funded in the blood transfusion safety development project in Togo financed by the Agence française de développement (AFD, French development agency).

Posterior urethral injury in male children: long-term follow up.

OBJECTIVE: Owing to the immature pelvis and the relative intra-abdominal position of the child's bladder, children with a posterior urethral injury differ from adults. We report our experience in the management of such injuries in male children. PATIENTS AND METHODS: Children with suspected urethral injury underwent retrograde urethrography once their clinical condition was stable. Children with complete urethral injury underwent primary urethral realignment either endoscopically or by open surgical technique. Suprapubic cystostomy was performed in other children who were unfit to undergo primary realignment or in whom the management of other injuries took precedence over that of urethral injury. Children referred from elsewhere for further management of urethral injury and those with initial suprapubic cystostomy underwent delayed urethroplasty. RESULTS: Twenty-two children with mean age of 11.3 years were treated at our centre for urethral injury. Seven children underwent primary endoscopic urethral realignment, five open surgical realignment and 10 initial suprapubic cystostomy followed by delayed urethroplasty. Six of the 12 children undergoing primary urethral realignment required additional endoscopic urethrotomy for managing the stricture, and three of these six children eventually underwent urethroplasty. Of the 10 children undergoing delayed urethroplasty, three required additional sessions of endoscopic urethrotomy and two of these required further correction graft urethroplasty. CONCLUSION: Most male children with posterior urethral injuries need immediate realignment to prevent long-term complications.

[Pott's disease paraplegia in children. Mechanics and therapeutic strategies. Six cases]. / Paraplégie d'origine pottique chez l'enfant. Mécanismes et stratégies thérapeutiques. A propos de 6 cas.

PURPOSE: We report a series of 6 Pott's disease paraplegias treated between 1982 and 1996. MATERIALS AND METHOD: Out of 15 children suffering from Pott's disease, 6 had paraplegia. Treatment consisted of anterior medullar decompression and anterior spine fusion with bone grafting. Two or three weeks later, posterior spine fusion was achieved systematically using a CD fixation device in 3 cases. RESULTS: Neurological signs completely disappeared in 5 children. Vertebral fusion was correct in all patients and kyphosis was less than 50 degrees. DISCUSSION: The posterior approach to the spine must be proscribed as a first step, except for spine dislocation. The anterior approach allowed us to drain the abscess, to correct the kyphosis, and to perform an anterior spine fusion. The posterior spine fusion was performed a few weeks later in order to avoid kyphosis aggravation. CONCLUSION: Prognosis of Pott's disease is good but at the present time, paraplegia remains too frequent. Adapted treatment must be performed without delay.

Vessel counts and expression of vascular endothelial growth factor as prognostic factors in node-negative colon cancer.

BACKGROUND: The value of these prognostic factors was compared with that of other clinicopathologic factors such as tumor grade, tumor stage, mucin production, vascular invasion, perineural invasion, and lymphatic invasion. OBJECTIVE: To determine whether the development of distant recurrence in patients with node-negative colon cancer could be predicted using vessel count and vascular endothelial growth factor (VEGF) expression. DESIGN: Paraffin-embedded colon cancers were immunostained for factor VIII, VEGF, basic fibroblast growth factor, and proliferating cell nuclear antigen; slides were reviewed for differentiation, mucin production, and the presence of vascular, lymphatic, and/or perineural invasion. SETTING: A large academic cancer referral center where 27 patients with node-negative colon cancer were operated on during 1988 and 1989. MAIN OUTCOME MEASURE: The development of and interval to recurrence. RESULTS: Eight patients developed liver, lung, or lymph node metastases at a median of 24 months. The median follow-up for patients without cancer recurrence was 60 months. The mean tumor vessel count for those patients who remained disease-free was significantly fewer than for those patients who suffered a recurrence (20 vs 33, respectively). By univariate analysis, 3 factors- perineural invasion, vessel count, and VEGF expression- were correlated with time to recurrence. By multivariate analysis, only vessel count was significantly related to differences in time to recurrence. Expression of VEGF correlated with vessel count. CONCLUSION: Vessel count and expression of VEGF may be useful for predicting distant recurrence in patients with node-negative colon cancer.

Carcinoid tumors of the rectum: effect of size, histopathology, and surgical treatment on metastasis free survival.

BACKGROUND: The purpose of this study was to determine the clinical course, effects of specific tumor histopathologic characteristics, and extent of surgical treatment on the metastatic rate in patients with rectal carcinoids. METHODS: Medical records of 44 patients who presented with rectal carcinoids were retrospectively reviewed. Primary tumors were classified by size (< 1 cm, 1-2 cm, and > 2 cm), and tumor histopathologic features (atypical or typical). Extensive surgery was defined as abdominoperineal or low anterior resection of the rectum or laparotomy with intent of curative resection. RESULTS: Median follow-up for patients who presented without metastasis was 84 months. Thirteen of the 44 patients (30%) presented with metastatic disease. The 5-year metastasis free survival rates for those patients presenting without metastatic disease were 100% for patients with tumors < 1 cm (n = 16), 73% for those with tumors 1-2 cm (n = 8), and 25% for those with tumors > 2 cm (n = 4) (P = 0.04 comparing < 1 cm with 1-2 cm and P = 0.05 comparing 1-2 cm with > 2 cm); tumor size data were not available for 3 patients. The 5-year metastasis free survival rate for patients presenting without metastatic disease with typical histology (n = 20), regardless of size, was 100%, compared with 50% for patients with tumors with atypical histology (n = 11) (P = 0.001). Nine patients underwent extensive surgery for rectal carcinoid tumors but no survival benefit was demonstrated. CONCLUSIONS: Atypical histopathologic features and a tumor size > 1 cm are associated with aggressive behavior of rectal carcinoid tumors. Extensive surgery offers no survival advantage over local excision for patients with rectal carcinoid tumors.

[Injuries of the external male genital organs. Apropos of 20 cases]. / Traumatismes des organes génitaux externes masculins (Togem). A propos de 20 cas.

The authors report 20 cases of trauma of the male external genital organs observed over a 10-year period, due to various causes, particularly road accidents, domestic quarrels, and self-mutilation. Lesions of the testis and its appendages were frequent and treatment was usually surgical.

Regulation of genes associated with angiogenesis, growth, and metastasis by specific p53 point mutations in a murine melanoma cell line.

K1735 murine melanoma cells transfected with p53 cDNAs bearing specific point mutations are metastatic in nude mice, whereas the parent and control-transfected cells are nonmetastatic. To determine whether p53 gene mutations regulate genes associated with angiogenesis, growth, and metastasis, we examined expression of vascular endothelial growth factor I, IGF-I receptor, epidermal growth factor insulin-like growth factor I, IGF-I receptor, epidermal growth factor receptor, c-MET, and thrombospondin 1 in K1735 cells transfected with one of four different mutant p53 cDNAs. Northern blot analysis demonstrated differential upregulation of these genes in cells transfected with different mutant p53 cDNAs. Up-regulation of angiogenesis-, growth-, and metastasis-related genes by mutant p53 may contribute to metastasis formation.

Regulation of vascular endothelial growth factor expression in human colon carcinoma cells by cell density.

To determine the effect of cell density on vascular endothelial growth factor (VEGF) expression and the mechanism of this effect, four human colon cancer cell lines were grown as sparse or confluent monolayers or as spheroids. VEGF mRNA increased > 2-fold in cells grown as confluent monolayers or spheroids compared with cells grown as sparse monolayers. Semiquantitative reverse transcription-PCR demonstrated a 2-fold increase in the larger VEGF mRNA isoform (189 bp) in confluent cells. Sparse cells grown in conditioned medium from confluent cells demonstrated a > 2-fold increase in VEGF mRNA. These data suggest that VEGF expression may be regulated by an unidentified soluble factor.

Cell density-dependent regulation of basic fibroblast growth factor expression in human renal cell carcinoma cells.

We investigated some of the mechanisms that regulate the expression of basic fibroblast growth factor (bFGF) in human renal cell carcinoma (HRCC). HRCC SN12PM6 cells were cultured as adherent monolayers. The expression of steady-state bFGF mRNA (measured by in situ hybridization and Northern blot) and protein (measured by immunohistochemistry and ELISA) correlated inversely with the culture density. Tumor cells harvested from dense cultures (low bFGF expression) and plated under sparse conditions expressed high levels of bFGF mRNA and protein prior to cell division, suggesting that bFGF may be a competence factor. Similar data were obtained with human vascular endothelial cells. The expression of bFGF was not regulated by spent culture medium, cell cycle, or rate of cell division but was down-regulated by contract inhibition. These data show that the expression of bFGF in HRCC is cell density dependent.

Les hernies ombilicales etranglees chez l'enfant au CNHU de Cotonou : a propos de 11 cas

L'etranglement herniaire ombilical est repute rarissime en Europe. Il n'en est pas de meme en Afrique noire et au Benin. Les auteurs ont analyse 111 cas de hernies ombilicales etranglees operees en 22 ans chez l'enfant. La moyenne annuelle est de 5 cas. Les hernies ombilicales etranglees chez l'enfant sont aussi nombreuses que les hernies anguinales etranglees. Les enfants de 9 mois a 5 ans ont ete les principales victimes; en particulier les nourrissons de 9 mois a 30 mois qui ont represente 54;96 pour cent des cas. Les hernies de petit volume ont ete les plus nombreuses. Les visceres etrangles (grele; epiploon) ont ete reseques dans 9 cas. La mortalite a ete de 1;80 pour cent. Les auteurs preconisent une intervention chirurgicale prophylactique dans les cas d'engouement herniaires ombilicaux

Mortalite a la Clinique Universitaire de Chirurgie Pediatrique du C.N.H.U. de Cotonou du 1er juillet 1989 au 31 decembre 1993

Une etude retrospective portant sur 3363 dossiers d'enfants admis a la Clinique Universitaire de Chirurgie Pediatrique du C.H.N.U. de Cotonou; du 1er juillet 1989 au 31 decembre 1993 a enregistre 161 deces donnant un taux de mortalite globale de 4;78 pour cent. 97;51 pour cent des deces concernaient des enfants hospitalises en urgence. Le deces etait survenu dans 42 pour cent des cas au cours des 24 heures suivant l'admission des enfants a l'hopital. 54;65 pour cent des patients decedes etaient des nouveau-nes ou des nourrissons. Les causes des deces venaient par ordre de frequence: des occlusions; des peritonites; des brulures; des traumatismes et des malformations autres que celles du tube digestif