A Case of Rare Complication of Inguinal Parietoplasty according to Lichtenstein: Entero Cutaneous Fistula.

Lichtenstein intervention is currently the classic model of the regulated treatment of inguinal hernias by direct local approach. This "tension-free" technique satisfies both patients and practitioners. However, it does not often evade severe complications of parietal surgery. The authors report their treatment experience in rural Africa of a late enterocutaneous fistula which aggravated an inguinal hernia repair according to the Lichtenstein procedure. Physiopathology, diagnosis, and treatment of that disease are analyzed in the light of literature.

Abcès du muscle psoas révélant une infection à VIH

Les auteurs rapportent l'observation d'un volumineux abcès primitif du muscle psoas révélateur d'une infection à VIH chez un adulte sans antécédent ni co-morbidité connus. L'abcès primitif du psoas est une affection rare. Son association avec l'infection à VIH apparait singulière. Nous exposons les particularités étiopathogéniques de cette association pathologique et les possibilités diagnostiques au regard de la littérature. La lombotomie reste notre traitement de choix des volumineux abcès du muscle ps

Dimensional anxiety scales for DSM-5: sensitivity to clinical severity.

PURPOSE: Psychometric properties and clinical sensitivity of brief self-rated dimensional scales to supplement categorical diagnoses of anxiety disorders in the DSM-5 were recently demonstrated in a German treatment seeking sample of adults. The present study aims to demonstrate sensitivity of these scales to clinical severity levels. METHODS: The dimensional scales were administered to 102 adults at a university outpatient clinic for psychotherapy. Diagnostic status was assessed using the Munich-Composite International Diagnostic Interview. To establish a wide range of clinical severity, we considered subthreshold (n=83) and threshold anxiety disorders (n=49, including Social Phobia, Specific Phobia, Agoraphobia, Panic Disorder, and Generalized Anxiety Disorder). RESULTS: Individuals with either subthreshold or threshold anxiety disorder scored higher on all dimensional scales relative to individuals without anxiety. In addition, individuals with a threshold anxiety disorder scored higher on the dimensional scales than individuals with a subthreshold anxiety disorder (except for specific phobia). Disorder-related impairment ratings, global functioning assessments and number of panic attacks were associated with higher scores on dimensional scales. Findings were largely unaffected by the number of anxiety disorders and comorbid depressive disorders. CONCLUSION: The self-rated dimensional anxiety scales demonstrated sensitivity to clinical severity, and a cut-off based on additional assessment of impairment and distress may assist in the discrimination between subthreshold and threshold anxiety disorders. Findings suggest further research in various populations to test the utility of the scales for use in DSM-5.

Postpancreatectomy hemorrhage (PPH): predictors and management from a prospective database.

BACKGROUND: Postpancreatectomy hemorrhage (PPH) is a dreaded complication in pancreatic surgery. Today, there is a definition and grading of PPH without therapeutic consensus. We reviewed our prospective database to identify predictors and assess therapeutic strategy. METHOD: We included all patients who underwent pancreatectomy between 2005 and 2010. Data were collected prospectively. We used the International Study Group Of Pancreatic Surgery (ISGPS) definition for PPH to include patients in the PPH group. RESULTS: Forty-six of 285 patients showed a PPH (16.1 %). The ISGPS classification was graded A = 3, B = 26, and C = 17. The average time to the onset of PPH was 7 days. CT-scan identified the origin of PPH in 43.5 % of the cases. PPH was responsible for a longer duration of hospital stay (p = 0.004), a higher hospital mortality (21.7 vs 2.5 %, p < 0.0001) and a lower survival (40 vs 70 % (p = 0.05) at 36 months). The first-intention treatment of PPH was conservative in 32 % and interventional in 68 %: endoscopy (6.4 %), transcatheter arterial embolization (TAE, 30.4 %), and surgical (30.4 %). In multivariate analysis, predictors of PPH were: pancreatic fistula (24 vs 8 % p = 0.028), pancreatoduodenectomy (70 vs 43 % p = 0.029), age (61.6 vs 58.8 %, p = 0.03), and nutritional risk index (NRI) (p = 0.048). CONCLUSION: In our series, risk factors for PPH were age, pancreatic fistula, pancreatoduodenectomy, and NRI. Its occurrence is associated with significantly higher hospital mortality and a lower survival rate. Our first-line treatment was radiological TAE. Surgical treatment is offered in case of failure of interventional radiology or in case of uncontrolled hemodynamic.

[An uncommon complication of unsafe induced abortion: bowel prolapse through uterine perforation]. / Une complication rare mais grave des avortements provoqués clandestins : l'évisceration iléale per vaginum.

The authors report one case of bowel prolapse through uterus following induced abortion. The eviscerated bowel was completely gangrenous, devoided from its mesentery and entrapped in the uterus wall. The treatment was a bowel resection and ileo-ileum anastomosis; the uterus was evacuated of retained products of conception and then sutured. The patient recovered uneventfully; fertility prognosis is expected to be poor because of abortion sequelae. If the abortion law still remains in Ivory Coast, more effort should be directed at reducing the incidence of unwanted pregnancy. This could be best archived by a better information on contraception and better health education programs.

Facilitating grant proposal writing in health behaviors for university faculty: a descriptive study.

Grant proposal writing in the behavioral sciences is important for fiscal reasons and scientific reasons at many universities. This report describes a grant proposal-writing seminar series provided to University faculty (N = 20) and explores factors facilitating and impeding writing. Summary statistics are provided for quantitative data. Free responses were sorted by independent raters into meaningful categories. As a consequence of the training, 45% planned to submit within 18 months; 80% of grant proposals targeted NIH. At 1-year follow-up, 40% actually submitted grants. Factors impeding grant proposal writing included competing professional demands; factors facilitating writing included regularly scheduled feedback on written proposal sections and access to expert collaborators. Obtaining grants generates financial resources, facilitates training experiences, and vastly contributes to the growth and dissemination of the knowledge base in an area.

Morbidity and mortality of Hartmann's procedure for sigmoid volvulus at the University Hospital of Cocody, Abidjan.

BACKGROUND: The restoration of intestinal continuity following Hartmann's procedure is associated with high morbidity and mortality rates and low restoration rate. OBJECTIVE: To determine the causes of complications and deaths associated with Hartmann's procedure and the secondary restoration of digestive continuity for sigmoid volvulus. METHODS: This was a retrospective study involving 25 patients treated for sigmoid volvulus according to Hartmann's procedure, from January 1998 to January 2008; at the Cocody university hospital, Abidjan (Cote d'Ivoire). The mortality and morbidity rates were assessed on the basis of the age, the duration of illness, the ASA (American Society of Anesthesiologists) score, the state of the sigmoid colon and peritoneal cavity. RESULTS: The mean age of the patients was 42.52 years (range: 22-77 years). The mean duration of illness was 02.80± 0.71 days (range: 06 hours to 07 days). Sixteen (64%) of the patients had an ASA score lower than III. The mean length of intervention was 209.75 min.±102.530 min. (range: 120 min. to 327 min). The mortality rate was 12% (n=3) in the Hartmann's procedure. The necrosis state of the sigmoid colon was not significantly associated with a higher death risk (p=0.071) but the contamination of the peritoneal cavity by stools (p=0.001) or an ASA score ≥3 (p=0.036) was significantly associated with a higher death risk. Infections of the operative site (42.86%) were the most common complications. The mean length of hospital stay was 12.05 ± 25.45 days. Eleven patients (50%) out of 22 had the intestinal continuity restored. The median time of restoration was 3.43 months (range: 3-12 months).The mortality rate among the restoration group was nil and the morbidity rate was 27.27% represented by parietal suppurations only. The mean length of hospital stay was 14 ± 2.83 days. CONCLUSION: Hartmann's procedure remains associated with an significant mortality. Morbidity, essentially arises from infections of the operative site. However the restoration of the intestinal continuity remains a sure intervention with an acceptable morbidity.

[Strangulated groin hernia still frequent in tropical milieu]. / Les hernies étranglées de l'aine : une urgence chirurgicale toujours d'actualité en milieu tropical.

This study aimed to describe the epidemiological, clinical, therapeutic and postoperative data of strangulated groin hernia. Details of consecutive adults patients admitted to our emergency wards for strangulated groins hernia and operated on from august 1998 to december 2007 were recorded. In addition the mode of presentation, hernia type, treatment and outcome were also recorded for each case. The statistical analysis used the Chi2 test and the Fischer test. 149 strangulated groin hernias were recorded in 135 men and 14 women. Inguinal hernias were seen in 143 patients and femoral hernia in 6. Median age was 40 years. The mean delay for consultation was 2 days. Richter hernia, Maydl hernia and hernia abscess were seen in eight, two and three cases each. Bowel resection was required in 30 patients. Inguinal hernia underwent Bassini's procedure, Shouldice procedure and Mac Vay's procedure. While femoral hernia underwent only Mac Vay's procedure. No hernia repair was undergone in hernia abscess. Mortality was 10%. Bowel necrosis, long duration of symptoms, ASA class, bowel resection and strangulated groin hernia with hernia abscess, peritonitis and occlusion were found to be significant factors linked with unfavorable outcome. Morbidity was 16.7% and required reoperation in 9 patients; sepsis and hematoma were the most frequent complication. In conclusion, strangulated groin hernia still remain a frequent matter of consultation in visceral ward in tropical milieu. The high morbidity and mortality rate are unacceptable because of the possibility of avoiding them by early consultation and elective repair of groin hernia.

[Nontraumatic digestive surgical emergencies in elderly patients at the Cocody University Hospital Center in Abidjan, Côte d'Ivoire: etiology and outcome]. / Urgences abdominates digestives non traumatiques chez les sujets âgés au CHU de Cocody à abidjan, Côte d'Ivoire: étiologies et résultats thérapeutiques.

OBJECTIVES: The purpose of this retrospective report is to describe etiologies and therapeutic outcomes of nontraumatic abdominal surgical emergencies in elderly patients. MATERIAL AND METHODS: The charts of patients aged 60 years or more who underwent emergency surgery for nontraumatic abdominal disorders at a Teaching Hospital in Abidjan, Cote d'Ivoire from August 1998 to July 2008 were reviewed. Demographic data, clinical findings, operative protocols, and postoperative outcomes were noted. RESULTS: A total of 137 patients with a mean age of 68.3 years (range, 60-93 years) underwent emergency surgery for nontraumatic abdominal disorders during the study period. The underlying etiologies were strangulated hernia (n = 40), abdominal parietal abscess (n = 6), bowel obstruction (n = 32), acute diffuse peritonitis (n = 29), acute appendicitis (n = 23), acute cholecystitis (n = 6) and massive rectorragy from colonic diverticulitis (n = 1). Coexisting medical problems (n = 84) were noted in 69 patients. Surgical procedures were tailored to operative findings. Twenty-seven patients were admitted to the intensive care unit in the immediate postoperative period. Mean hospital stay was 7.7 days (range, 2-23 days). Surgical complications included wound infection (n = 14), stoma-related complications (n = 7), digestive fistula (n = 4), scrotal hematoma (n = 5) and postoperative evisceration (n = 2). The mortality rate was 10.21% (n = 14) mainly due to postoperative peritonitis. CONCLUSION: The findings of this study indicated that most nontraumatic abdominal surgical emergencies in elderly patients were related to complications of neglected or undiagnosed preexisting disease. Prognosis was related to the stage of the disorder, initial surgical management, and deterioration of the coexisting medical problems.

[Colonoscopic perforation: 6 cases in Abidjan, Cote d'Ivoire]. / Plaies coliques per coloscopiques: 6 observations à Abidjan (Côte d'lvoire).

OBJECTIVES: The purpose of this report is to describe diagnostic and therapeutic management of colonoscopic perforation and identify risk factors. MATERIAL AND METHODS: The charts of 6 patients who underwent surgery for colonoscopic perforation between January 2003 and December 2008 were reviewed. Study data included patient age, indication for colonoscopy, operative findings, repair technique, and outcome. RESULTS: All 6 perforations occurred during diagnostic colonoscopy. There were 5 females and 1 male. Endoscopy was performed by an experienced operator in 5 cases and by a training fellow in 1. Preparation of the colon was considered as good in 5 cases. The operator reported procedural problems in only 1 case. Diagnosis of perforation was immediate in 5 cases and delayed for 30 hours in 1. The lesion was located in the sigmoid colon in 5 cases and transverse colon in 1. All patients underwent laparotomy. The repair technique consisted of simple closure in 2 cases, closure with colostomy in one, and bowel resection with anastomosis (n=2). Two deaths occurred intraoperatively in I case and postoperatively in 1. The patient who died intraoperatively had not yet undergone repair when death occurred. In both patients who died, laparotomy was performed late in the presence of co-morbidity. CONCLUSION: Colonic perforation is a rare but severe iatrogenic complication following colonoscopic examination. Early recognition and treatment are essential to optimize outcome. Prevention depends on training to obtain skillful advancement technique.

Isolated gastric outlet obstruction due to corrosive ingestion.

OBJECTIVES: To analyze the diagnostic and therapeutic aspects of isolated gastric outlet obstruction secondary to corrosive ingestion. PATIENTS AND METHODS: Retrospective chart review of eight patients who developed gastric stricture following corrosive ingestion and were treated in the Digestive and General Surgery Service of Yopougon Teaching Hospital in Abidjan from 1991 to 2009. RESULTS: Six men and two women (mean age of 34.3 [range 21 to 48 years]) had isolated gastric outlet obstruction following accidental (n=2) or suicidal (n=6) acid ingestion. Two patients sought hospital medical attention two days after ingestion, whereas six patients came to hospital with a mean delay of 60.8 days (range 12 and 96 days). Patients sought medical attention for poor general status (n=6), postprandial vomiting (n=4), early satiety (n=2) and retrosternal pain (n=2). Two patients, who presented early to hospital, underwent upper gastrointestinal tract endoscopy the day after admission and then received a feeding jejunostomy whereas the esogastroduodenal barium swallow and feeding jejunostomy were performed after a mean delay of 2 days (range 1 and 3 days) and 3 days (range 1 and 5 days), respectively. The findings at upper endoscopy and barium swallow were: microgastria (n=2), midgastric stricture (n=1), antropyloric stricture (n=4) and gastric body stricture (n=1). One patient died preoperatively as the result of severe nutritional depletion. A follow-up endoscopy and barium swallow were performed respectively 21 and 35 days later. Definitive surgery was performed after a mean delay of 85 days (range 74 to 123 days) in the remaining seven patients. Gastric lesions were managed by total gastrectomy with Roux-en-Y esophagojejunostomy (n=2), partial gastrectomy with gastrojejunostomy (n=2) or simple gastrojejunostomy (n=3). During the mean follow-up period of 4 years (range 1 to 7 years), all patients were free of symptoms. CONCLUSION: Isolated corrosive gastric stricture is relatively rare. Surgery tailored according to the extent of gastric stricture provides excellent results.

[Gunshot wound to gravid uterus: a case report]. / Plaie Balistique Pelvi-Abdominale Chez une Gestante.

The authors report the case of a 24-years old pregnant woman gravida 2 para 1 who sustained a gunshot injury at 23 weeks gestation. The bullet injured the rectosigmoid jonction, the jejunum and traversed the uterine cavity with resultant of fatal injury of the fetus. Laparotomy was required for treatment of the maternal injuries. Although a fetus demise was delivered by caesarian section a review of literature indicated that operative delivery should be avoided when the fetus has died already and the gravid uterus don't impaired the surgeon's ability to repair other visceral injuries. But the patient should be followed closely for signs of coagulopathy and intra uterine infection.

[Early oral feeding versus classic oral feeding after appendicectomy for acute appendicitis]. / Réalimentation orale précoce versus réalimentation orale classique après appendicectomie pour appendicite aiguë.

The appendectomies for acute appendicitis are the most frequent surgical interventions (43.6%) in our service. The recent studies demonstrated the feasibility and the economical gain of the early oral feeding vs. classic oral feeding, after elective digestive surgery. We wanted to spread these results therefore to the appendectomy for acute appendicitis. It is about a prospective survey carrying on 110 patients also left in two groups, and comparing the classic postoperative oral feeding vs. the early postoperative oral feeding on one year. The two groups were comparable and the studied parameters were : the length of the postoperative ileus, the hospitable morbidity, the length of the hospitalization and the cost of the hold in charge. The length of the postoperative ileus was not different in the two groups as well as the morbidity. The difference of the median length of hospitalization in the two groups was not meaningful. The cost of the hold in charge was meaningfully more elevated in the group with classic postoperative feeding. In conclusion, the early postoperative oral feeding in our survey doesn't reduce the length of the postoperative ileus and don't drag a morbidity anymore that the classic oral feeding. However if it doesn't shorten the length of the hospitalization, it drags a reduction of the cost of the hold in charge. There is a gain therefore precociously to nourish the patients after appendectomy for acute appendicitis.

[Post-operative morbidity and mortality in non traumatic colon emergencies]. / Morbidite et mortalite post-operatoire des urgences coliques non traumatiques a propos de 85 interventions.

UNLABELLED: This study aimed to evaluate emergency non traumatic colonic surgery mortality and morbidity in our practice MATERIAL AND METHODS: Data of all 85 patients who underwent an emergency non traumatic colonic surgery during the period from August the 1st 1998 to June the 30th 2006, were retrospectively reviewed. Surgical procedures included either colonic resections with (n = 33) or without (n = 47) immediate anastomosis or, ileostomies (n = 3) or colostomies (n = 2) without colonic resection. RESULTS: A 16.5% (n = 14) mortality rate was recorded due to septic shock (n = 6), postoperative peritonitis (n = 2), stroke (n = 2) and cachexia, malnutrition, acute anemia, acute heart failure (n = 1 each). Morbidity rate was 38.8% (n = 33). Surgical complications (n = 29 34.1%) were related to wound infection (21.1% n = 18), stoma related (n = 6), post-operative peritonitis due to an anastomotic dehiscence and prolonged ileus (n = 2 each), rectorragy (n = 1). Medical complication reached a 4.7% rate and included malaria (n = 2), acute pulmonary edema, diabete acido cetosis (n = 1 each). Seven patients (8.2%) needed a reoperation for post operative complication. Hospital stay was 19.4 days. CONCLUSION: Post-operative morbidity and mortality in non traumatic colon emergencies still remain high owing to anastomotic leak, patients comorbidities and infectious complications.

Validation of the Marijuana Effect Expectancy Questionnaire-Brief.

The purpose of this study was to evaluate a brief version of the Marijuana Effect Expectancy Questionnaire (MEEQ; Schafer & Brown, 1991). The original MEEQ was reduced to 6 items (MEEQ-B). Principal component analysis (PCA) was performed and two factors were identified (positive effects and negative effects) accounting for 52.3% of the variance. Internal consistencies (0.42 to 0.60) were slightly lower than those of the original MEEQ. The negative effect expectancy scale correlated with criterion variables that assess marijuana use (p ≤ .05). This measure is a helpful tool for clinicians to use when assessing youth expectancies. Replication across different samples of adjudicated youth is recommended.

Morbidite et mortalite post-operatoire des urgences coliques non traumatiques a propos de 85 interventions

Evaluer la mortalite et la morbidite de la chirurgie des urgences coliques non traumatiques dans notre pratique. Methodologie : Dans une etude retrospective couvrant la periode du 1er aout 1998 au 30 juin 2006; nous avons revu les dossiers de 85 patients operes pour une urgence colique non traumatique. Les methodes chirurgi- cales etaient soit des resections coliques avec (n=33) ou sans (n=47) anastomoses; soit des ileostomies (n=3) ou colostomies (n=2) sans resection. Resultats : La mortalite post-operatoire a ete de 14 deces (16;5) par choc toxi-infectieux (n=6); peritonite post-operatoire (n=6); accident vasculaire cerebral (n=2) et; par anemie aigue; insuffisance cardiaque; denutrition et cachexie (un cas chacun). Des complications non mortelles ont ete notees chez 33 patients (38;8). Celles liees a la chirurgie (n= 29 ; 34;1) regroupaient 18 suppurations parietales (21;1; n=18) ; trois necroses stomiales; deux abces peristomiaux; une dermite peristomiale; deux ileus prolonges; deux peritonites post-operatoires par lachage d'une anastomose colorectale et un cas de rectorragie . Les complications medicales (4;7n=4) etaient deux acces palustres; une acidocetose diabetique et un oedeme aigue du poumon. Des reinterventions ont ete necessaires chez sept patients (8;2). La duree moyenne d'hospitalisation a ete de 19;4 jours. Conclusion : La mortalite et la morbidite de la chirurgie des urgences coliques non traumatiques sont elevees; en rapport avec les complications infectieuses; les decompensations de tares et les fistules coliques

[Psoas abscess in Cote d'Ivoire: a report of eighteen cases]. / Les abces du psoas en Cote d'Ivoire: a propos de 18 cas.

BACKGROUND: Psoas abscess is a rarely encountered entity with a non specific clinical presentation resulting in delayed diagnosis and treatment. No published data exist on this disease in our country. OBJECTIVE: To describe the diagnostic and therapeutic features of psoas abscesses in Côte d'Ivoire. Methodes: A retrospective study of 18 psoas abscesses seen over seven years in two teaching hospitals. RESULTS: There were 10 women and eight men with a mean age of 35.7 years (range:16-62 years). The abscess was primary in 15 cases, secondary in three, right sided in 15 and left sided in three cases. Fever, abdominal pain, difficulties in walk, abdominal mass and psoitis were the main clinical signs. Ultrasonography allowed the diagnosis of psoas abscess in 14 cases and in the remaining 4 cases the diagnosis was done peroperatively. The germs were identified in 12 patients and were: Escherichia coli in 3 cases, Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumoniae, Klebsiella pneumoniae in two cases each and Mycobacterium tuberculosis in one case. Patients were given antibiotics together with surgical drainage of the abscess (n=16) or percutaneous needle aspiration (n=2). Postoperative complications included parietal suppurations (n=5) and intraperitoneal abscesses (n=2). No death occurred. CONCLUSION: For psoas abscess in our practice, ultrasonography is a useful diagnostic tool and surgical drainage remains an effective therapeutic method.

[Acute peritoneal tuberculosis in HIV-infected patients. Study of 4 cases in Abidjan, Côte-d'Ivoire]. / Péritonite aiguë tuberculeuse au cours de l'infection par le VIh. Etude de 4 cas à Abidjan, Côte-d'Ivoire.

This paper presents 4 cases of histologically verified peritoneal tuberculosis in HIV-infected patients followed in a 18 month-period. The patients were admitted in emergency and were suspected of present acute appendiceal peritonitis. There were 3 females of 18, 22 and 27 years old, and a 41-year-old male. The main symptoms were acute abdominal pain (4 cases), fever superior to 38 degrees C (4 cases) and abdominal defence (4 cases). Laboratory findings were hyperleucocytosis with lymphocytic predominance, anemia and CD4+ rate variable from 250 to 460/mm3. They underwent emergency laparotomy which led to diagnosis of peritoneal tuberculosis by histopathological analysis of peritoneal biopsies. Two patients died from surgery at days 3rd and 10th. The 2 remaining patients were successfully treated by tuberculostatic tritherapy with rifampicin, isoniazid, and pirazinamid. Acute peritoneal tuberculosis in HIV-infected patients is not to be missed in our practice. It must be considered in differential diagnosis of acute abdomens.

[Acute intestinal intussusceptions in adults: analysis of 20 cases]. / Invaginations intestinales aiguës de l'adulte: analyse d'une série de 20 cas.

AIM OF THE STUDY: To report our experience in the management of acute intestinal intussusceptions in adults. PATIENTS AND METHODS: Retrospective study of data of patients older than 15 years who were operated on for acute intestinal intussusceptions from January 1997 to December 2001. RESULTS: Twelve of the patients were males and eight females with an average age of 41 years (range: 16-71). The clinical and radiological findings were suggestive of bowel obstruction (N = 14), peritonitis (N = 5) and appendicular abscess (N = 1). Correct preoperative diagnosis of acute intestinal intussusceptions was established in 6 cases. Type of intussusception was jejunojejunal (N = 1), ileo-ileal (N = 8), ileocolic (N = 1), ileocecocolic (N = 7) and colocolic (N = 3). Necrosis was found in the intussusceptum in 10 cases and a tumor on the lead point in 14 cases (5 benign lesions and 9 malignant ones). For intussusception involving the colon, all patients underwent en bloc resection with immediate anastomosis, while intussusception located on the small bowel were treated by surgical reduction (N = 1), en bloc resection (N = 8) with immediate (N = 7) or delayed (N = 1) anastomosis. The mortality rate was 15%. CONCLUSION: In our experience, intussusceptions in adults is not an uncommon clinical entity but correct diagnosis is often established peroperatively. En bloc resection is recommended because of the frequency of neoplasms and bowel ischemia.