[Acute abdominal pain in children at the Pediatric Hospital in Bangui (Central African Republic). Epidemiological, clinical, paraclinical, therapeutic and evolutive aspects]. / Les douleurs abdominales aiguës chez l'enfant au complexe pédiatrique de Bangui (Centrafrique). Aspects épidémiologiques, cliniques, paracliniques, thérapeutiques et évolutifs.

UNLABELLED: Acute abdominal pains in children in general, and in subsaharian Africa in particular, are among the most frequent causes of consultations. MATERIAL AND METHODS: The authors achieved a two-year retrospective study on acute abdominal pains in children, with the objectives of determining the frequency of acute abdominal pains, precising the epidemiological, clinical, therapeutic and evolutive aspects and different aspects of the treatment. The study concerned 312 cases. RESULTS: A predominance of the ages three to ten years was noted (67% of the cases). Most of the patients were related to low income parents. Half patients were submitted to antiparasitical treatment before arriving at the hospital and they were treated mainly by antihelminthiasis. The diagnosis were appendicitis (32.4%), typhoid perforations (9.9%), digestive forms of acute malaria (5.8%), strangulated herniae (4.8%), acute gastroenteritis (4.8%), acute pneumoniae (3.8%), urinary tract infections (3.5%), amibian liver abscess (1.9%), viral hepatitis (1.6%), Schönlein Henoch purpura (1.3%), occlusive syndrome (1.3%) and other medical causes (2.2%). In 22.8% of the cases, no cause was found. CONCLUSION: The ignorance of the seriousness signals, late recourses to hospitals structures and the limited financial means explain the high rate of mortality (8%), mainly due to appendicitis and typhoid perforations.

[Acute appendicitis at the National University Hospital in Bangui, Central African Republic: epidemiologic, clinical, paraclinical and therapeutic aspects]. / Les appendicites aiguës au Centre National Hospitalier Universitaire de Bangui, Centrafrique: aspects épidémiologiques, cliniques, paracliniques et thérapeutiques.

We carried out a retrospective study to analyse clinical, paraclinical and therapeutic aspects of acute appendicitis cases as the National University Hospital (CNHU) at Bangui in the Central African Republic. We compared our findings with those for other African countries and for industrialized countries. From September 15 1990 to February 15 1992, 285 patients underwent laparotomy to treat acute appendicitis. We carried out a study of clinical, paraclinical and therapeutic aspects on 57 patients with complete case histories (20% of the patients undergoing surgery). The appendices of these patients were sent to the Laboratory of Pathological Anatomy of the Faculty of Medicine at Marseille, France, for analysis. The frequency of appendectomy among patients undergoing visceral surgery by laparotomy with no acute traumatic abdominal syndrome was 42.3%. The incidence of appendectomy for the city of Bangui in 1991 was 36.5 per 100,000 inhabitants. These cases of appendicitis were diagnosed essentially on clinical grounds. Leukocyte counts exceeded 10,000 per mm3 in 30% of the patients. Histological examination revealed the presence of parasites in 10 cases : Schistosoma mansoni eggs (seven cases) and Ascaris lumbricoides eggs (one case) in patients with acute appendicitis and one case each of Schistosoma mansoni eggs and Ascaris lumbricoides eggs at the time of diagnosis but normal histological results for the removed appendix. Most of the patients consulted late, a mean of four days after the onset of symptoms. The frequency of appendectomy on principle was 12.7% and parenteral antibiotic treatment was prescribed systematically follow- ing surgery. The mean duration of hospital stay after surgery was 7.6 days. No early postoperative complications were noted. However, two late postoperative complications resulting in the death of the patient were observed, giving a mortality rate of 3.5%. These complications were one case of peritonitis after appendectomy involving intestinal resection and one case of occlusive syndrome with septic shock. The frequency of acute appendicitis at the CNHU at Bangui was similar to that reported in another tropical African country (~ 1%). However, the incidence of appendectomies at Bangui is lower than generally reported for western countries (15 to 40%). Positive diagnosis was made on classic data obtained on clinical examination and on associated biological data, if available. Parasites were identified on histological examination in some cases of acute appendicitis, but it is unclear whether these parasites were actually responsible for the appendicitis. Efficient examinations for the exploration of acute nonspecific abdominal pain, such as the measurement of inflammation indicators, particularly serum activated protein C levels, graded-compression ultrasound scans and celioscopy, should be made available in the hospitals of African countries to increase the precision of diagnosis and to decrease the still too high frequency of appendectomies performed on principle. The postoperative mortality rate at the CNHU of Bangui is higher than the low rates (0.1 to 0.25%) reported for industrialized countries but is close to those reported for African countries. This high rate of mortality results partly from the lateness of consultations, because patients in tropical Africa often consult a traditional healer before resorting to modern medicine, and partly from misdiagnoses.

[Difficulties in the management of supracondylar fractures of the humerus in children living in Central African Republic]. / Difficultes dans la prise en charge des fractures supracondyliennes de l'humerus de l'enfant en Centrafrique.

Like many developing countries, the Central African Republic lacks the technology and skills to perform certain medical procedures. One example of this situation can be found in the Pediatric Surgery Department of Bangui with regard to first intention management of supracondylar fractures of the humerus (SCF). Due to a lack of proper technological facilities (e.g. absence of brightness enhancement) and to insufficient staff training, management of SCF must be limited to orthopedic reduction followed cast application and brachio-anti-brachio-palmar traction such problems. This retrospective study describes management of 119 cases of SCF involving children between the ages of 0 and 15 years. Special emphasis was placed on factors impairing outcome, namely, inadequate staff training, availability of brightness enhancement, and poor awareness on the part of the parents concerning the seriousness of SCF. The quality of reduction was compared according to whether reduction was done with or without brightness enhancement (reduction without brightness enhancement was imperfect in most cases: 78/119) and according to fracture grade (high number of imperfect reductions in grade 3 and 4:69%). Assessment of outcome at one month showed a high incidence of poor results due to severe fracture or imperfect reduction. A prospective study including 35 cases with a follow-up of three years showed poor results for the same reasons. Comparison of these results with those reported by previous authors showed a large gap which must be filled by upgrading technical facilities and training staff.

[Epidemiology of supracondylar fractures of the humerus in children in Bangui, Central African Republic]. / Epidémiologie des fractures supra-condyliennes de l'humerus chez l'enfant à Bangui, Centrafrique.

The purpose of this retrospective study was to evaluate the epidemiological, clinical, and anatomical aspects of supracondylar fractures of the humerus in children treated at the National University Hospital Center (NUHC) of Bangui, Central African Republic. Between January 1992 and March 1995 a total of 119 documented cases involving children between the ages of 0 and 15 years were treated. Most patients were boys (62%) between 3 and 8 years of age. Fracture occurred during play in 74% of cases on the left side (92 cases) more often than the right. The mechanism of fracture was extension in 115 of the 119 cases with only four open fractures. Most fractures (68.1%) were severe (Lagrange Grade 3 and 4). These findings which are comparable to those reported in other countries confirm the high incidence of supracondylar fracture of the humerus and need for appropriate treatment in African orthopedic facilities.

[Walking in children after poliomyelitis]. / Les possibilités de verticalisation et de marche chez l'enfant dans les séquelles de poliomyélite en milieu africain.

Between 1983 and 1990 the authors examined 630 children who had suffered from poliomyelitis, mostly between the age of one and three, at an average age of 9 years 3 months. Half were unable to walk because of residual paralysis. Operation was carried out on 252 children. Most underwent soft tissue release at the hips, knees or tendo Achilles. Triple arthrodesis was carried out on 24. Calipers, produced locally, were used, and trunk bracing was not employed. The average duration of treatment was 3 months, with gradual achievement of correction. Vascular complications occurred in one leg, there were 5 paralyses of the sciatic nerve and 4 fractures of the upper tibia. One hundred children who were not able to walk before operation were reviewed. Sixty five were walking and able to go to school. The best results were achieved before the age of 12.

[Reflexion on thirty eight cases of Monteggia fracture of children (author's transl)]. / Réflexion à propos d'une série de 38 fractures de Monteggia chez l'enfant.

The authors report thirty eight cases of Monteggia fractures, seven of which being old dislocations of the head of the radius. They insist on early diagnosis and treatment of recent fractures, with a successful result if the ulnar hache become rightly alined. In late untreated luxations of the head of the radius, they occasionally use fascia lata transplant to repair the annular ligament, after correction of ulnar hache. However, early diagnosis and immediate full treatment are the best for successful result.

[The infectious risk in neonatal surgery : an evaluation of frequency and consequences from a study of 300 cases (author's transl)]. / Evaluation et interprétation du risque infectieux en chirurgie néo-natale. A propos de 300 observations.

This study is an evaluation of the infectious risk related to neonatal surgery in 300 patients between 1968 and 1978, and its consequences to mortality and morbidity. Bacteriological species, circumstances, chronology of infection, related to each type of surgical pathology prove the endogenous way of contamination to be usual and predominant. When intestinal obstruction occurs, the risk of hematogenous diffusion is directly dependent from local stasis and bacterial pullulation which can be evaulated with duodenal, jejunal or fecal samples. Both mechanical factors and antibiotictherapy can induce qualitative and quantitative changes in bacterial flora of the bowel, and then increase the incidence of endogenous septicemia.