[Priapism in children and adolescents with homozygous sickle cell disease in Brazzaville]. / Priapisme chez l'enfant et l'adolescent drépanocytaire homozygote à Brazzaville.

OBJECTIVE: To determine the prevalence of priapism, assess knowledge and appreciate its characteristics in childhood sickle cell disease. METHODOLOGY: A case-control study was conducted at the University Hospital of Brazzaville (Department of Pediatrics, Hematology and Clinical Urology). The cases consisted of 202 sickle cell anemia who are at least 5 years. Witnesses consisted of 112 children with sickle cell disease not of the same age from the same family as the previous. RESULTS: Priapism was found in 68 (34%) affected children, divided into 54 cases (79.4%) of chronic intermittent priapism and 14 cases (20.6%) of acute priapism. In the control group no cases were observed (p=0.001). Priapism was known by six (3%) patients in the group of children with sickle cell disease. In the control group, it was known by 25 (22.3%) children. It was seen in the group of sickle cell disease as any: 113 children (56%), a natural phenomenon that can occur in life: 57 children (28%), a complication of sickle cell disease: 26 children (13%). In the control group, it was considered a natural phenomenon that can occur in life: 60 children (53.6%), a complication of sickle cell disease: 52 children (46.4%). The average age of priapism occurred in the first episode was 10.4±9.5 years. CONCLUSION: The importance of the prevalence of priapism, and insufficient knowledge needed strengthening information, education and communication with children and their parents.

[Erectile dysfonction after stroke in Brazzaville]. / Dysfonction érectile après un accident vasculaire cérébral à Brazzaville.

INTRODUCTION: Erectile dysfunction is one of the disability post-stroke the least documented. However, it affects the quality of life, not only the patient but also the couple. OBJECTIVE: The purpose of this work was to study the characteristics of erectile dysfunction after stroke. METHOD: This is a cross-sectional descriptive and analytical data collection survey conducted from February to October 2011, having identified, 104 patients for follow-up post-stroke, seen in outpatient Neurology University Hospital of Brazzaville and in the functional rehabilitation centers. Among them 54 had erectile dysfunction. The parameters studied were: age, marital status, history, vascular risk factors, and the location of the hemiplegic, the etiology of stroke, modified Rankin score and NIHSS. The clinical features and laboratory, the international index of erectile dysfunction (IIEF-5) in its French version. SPSS 12 was used for recording and statistical analysis of data. Chi(2) test was used for comparisons. The significance level was P≤0.05. RESULTS: The frequency of erectile dysfunction after stroke was 51.92%, the average age was 56.32 years. The mean time to onset of erectile dysfunction after stroke was 5 months. The onset was progressive in 70,4%. The hypercholesterolemia was well correlated with the risk of erectile dysfunction (P=0.007) and its severity (P=0,01). Erectile dysfonction was moderate in 61.1% and almost bearable in half the cases. CONCLUSION: Erectile dysfunction post-stroke is common with an impact in the lives of the couple. High cholesterol is an independent risk factor of occurrence of post-stroke.

[Open surgery of the urinary tract calculi at the university hospital of Brazzaville: analysis of 68 cases]. / Chirurgie a Ciel Ouvert de la Lithiase Urinaire au CHU de Brazzaville : Analyse de 68 Cas.

AIMS: To report epidemiological, clinical, and outcome of surgical therapeutic aspect of urinary calculi in our department. PATIENTS AND METHODS: This survey, retrospective, has been achieved from june 2000 to may 2004. It concerned 68 patients carriers of the urinary calculi, confirmed radiologically and operated. RESULTS: The patients carriers of the urinary calculi represented 7,3%. There was 52 men (76,47%) an 16 women (23,53%).The average age of the patient was 52,13 years (extreme : 14 et 82 years). Symptoms at the diagnostic was : atypical abdominal pen (n=18), dysuria (n=15), hematuria (n=15), la pollakiuria (n=9), nephretic colic (n=15), urinary retention (n=26). The location of urinary calculi was vesical (n=47), renal (n=8), pyelic (n=12), ureteral (n=1). All our patients was operated. The operative continuations one summer simple in 58 cases, and complicate of pariatal suppuration in 7 cases. Mortality was of 3 cases. CONCLUSION: The urinary lithiasis is little frequent. The open surgery is the only surgical technique that is practiced in our context.

Les cancers de la prostate avant l'age de 50 ans

Notre objectif a ete d'analyser des facteurs epidemiologiques; diagnostiques et evolutifs du cancer de la prostate chez le sujet de moins de 50 ans. Ce travail a ete fait de maniere retrospective a partir de sis dossiers du Service; rassembles entre 1998 et 2007. Deux patients avaient 48 ans et quatre 49. Certains antecedents particuliers ont ete notes / hypercholesterolemie; hypertension arterielle; cancer de la prostate chez un frere et androgenotherapie prolonge pour infertilite. Deux des six patients ont diagnostiques lors d'un depistage tandis que quatre avaient presente des signes cliniques. Le toucher rectal a fait suspecter le diagnostic chez quatre patients. Le PSA variait de 8 a 170ng/ml. Tous stadifies T1 N0 M0 avaient beneficie d'une prostatectomie radicale alors que les quatre T3 Nx M1 ont ete traites par hormonotherapie. Les deux patients operes sont cliniquement stables alors que les quatre autres ont une maladie evolutive avec deux deces

[Vulval bilharziasis]. / Localisation vulvaire de la bilharziose.

Vulvar localisation of schistosomiasis is a rare presentation. We report a case of a woman of 20 years old hospitalised for a vulvar mass of six months. That mass progressively increased in volume and was tender. It was accompanied by frequency and dysuria. The patient had a history of swimming in fresh water and hematuria when she was eight years old. Initial clinical examination found a good general state, there was a mass involving the clitoris and the small lips. This painless mass had a cauliflower appearance and was soft with a large implantation. Pathology exam of the mass revealed a vulvar schistosomiasis with an important amount of living eggs. A tumour removal with a plasty of small lips was performed. Additionally, praziquantel was administered orally. Vulvar localisation of schistosomiasis might suggest a malignant tumour. Only pathological examination can assess the diagnosis.

[Lymphatic drainage of intertracheobronchial lymph nodes. An anatomical study by injecting diaphragmatic pleura of foetuses and adult cadavers]. / Voies de drainage du groupe des lymphonceuds intertracheobronchiques. Révision anatomique a partir de l'injection de ia plèvre diaphragmatique de foetus et de sujets adultes.

The aim of this anatomical study was to determine lymphatic efferents from intertracheobronchial lymph nodes. The diaphragmatic vessels of 57 adult cadavers and 23 foetuses were injected with a modified Gerota's medium to permit, through diaphragmatic lymphatic efferents, intertracheobronchial lymph nodes and its lymphatic efferents to be visualised and then dissected. Each stage of the dissection was described and photographed. Ascending paratracheal efferents appeared to be the most important, particularly the right one. Unknown lymph pathways such as the right thoracic tracheo-oesophageal lymph collector were described. The important place of bronchial lymph nodes was demonstrated. Connexions to the thoracic duct and abdominal cavity, unknown, important in pathology was denmostrated. The intertracheobronchial lymph nodes are an important lymph center in the mediastinum. Many efferent pathways arise from it, particularly the right ascending paratracheal efferents.

[The ilioinguinal and iliohypogastric nerves. The anatomic bases in preventing postoperative neuropathies after appendectomy, inguinal herniorraphy, caesareans]. / Nerfs Ilioinguinal et Iliohypogastrique. Bases anatomiques de prévention des névralgies résiduelles après appendicectomies, cure de hernies inguinales, césariennes.

STUDY AIM: To identify danger areas in surgical incisions (appendectomy, inguinal and Pfannenstiel incisions) by mapping the course of ilioinguinal and iliohypogastric nerves. MATERIAL AND METHODS: The courses of the ilioinguinal and iliohypogastric nerves from 37 unembalmed adult cadavers were mapped from their lateral emergence on the internal obliquus nerve to their midline termination in reference to anatomic landmarks (anterior superior iliac spine, midline, upper border of the pubic symphysis). With use of a mapping technique, the standard courses of both nerves were compared with sites of standard abdominal surgical incisions. RESULTS: Sixty seven ilioinguinal and sixty four iliohypogastric nerves were identified and mapped. On average the ilioinguinal nerve perforated the internal obliquus muscles 3.30 cm medial and 3.27 inferior to the anterior superior iliac spine, and terminated its course 2.50 cm lateral to the midline and 1.92 cm superior to the upper border of the pubic symphysis. On average the iliohypogastric nerve perforated the internal obliquus muscles 2.30 cm medial and 1.20 cm inferior to the anterior superior iliac spine, and terminated its course 3.10 cm lateral to the midline and 4,80 cm superior to the upper border of the pubic symphysis. CONCLUSION: Surgical incisions performed below the level of the anterior superior iliac spine carry the risk of injury to the ilioinguinal and iliohypogastric nerves.

Voies de drainage du groupe des lymphonoeuds intertracheobronchiques. Revision anatomique a partir de l'injection de la plevre diaphragmatique de foetus et de sujets adultes

Le but de cette etude anatomique etait de preciser les differentes voies de drainage du volumineux groupe des lymphonoeuds intertracheobronchiques. Les vaisseaux lymphatiques de la plevre diaphragmatique de 23 foetus et de 57 sujets adultes ont ete injectes avec une masse de Gerota modifiee de facon a opacifier a partir d'afferences diaphragmatiques; le volumineux groupe des lymphonoeuds intertracheobonchiques et ses differentes voies de drainage. Chacun des temps de la dissection a ete decrit et photographie. Le drainage efferent apparait essentiellement paratracheal ascendant et plus souvent droit que gauche. Une voie moins connue des anatomistes classiques; la chaine tracheo-oesophagienne thoracique droite; a ete individualisee. Le role et la topographie du groupe des lymphonoeuds sus-bronchiques gauches appendu au groupe des lymphonoeuds intertracheobronchiques; diversement apprecies par les anatomistes classiques; ont ete precises. Des liaisons directes ou indirectes avec le conduit thoracique et l'abdomen; moins connues; controversees; d'importance considerable en pathologie ont ete mises en evidence. Le volumineux groupe des lymphonoeuds intertracheobronchi-ques est un veritable carrefour de la lymphe. Ses voies de drainage sont essentiellement paratracheales ascendantes plus souvent droites que gauches

Nerfs ilioinguinal et oliohypogastrique. Bases anatomiques de prévention des névralgies résiduelles après appendicectomies; cure de hernies inguinales; césariennes

But : Determiner des zones a risque en evaluant le trajet des deux nerfs par rapport aux incisions parietales abdominales classiques. Materiel et methodes : Le trajet des nerfs ilioinguinal et iliohypogastrique a ete etudie chez 37 sujets anatomiques adultes; non embaumes; de mort recente; par dissection des regions inguinales. Les points d'emergence des nerfs au niveau du muscle oblique interne et les points de terminaison ont ete determines. Ont ete mesurees les distances de ces points d'emergence et de terminaison par rapport a l'epine iliaque antero-superieure; a la ligne mediane et au bord superieur de la symphyse pubienne. Ont ete egalement mesurees les distances entre les epines iliaques antero-superieures; entre les epines iliaques antero-superieures et l'ombilic; entre le bord superieur de la symphyse pubienne et l'ombilic. Sur un schema etabli a partir des diffe- rents reperes anatomiques et mesures moyennes; le trajet standard des deux nerfs etait compare aux incisions parietales abdominales classiques. Resultats : Le nerf ilioinguinal etait retrouve dans 67 cas; le nerf iliohypogastrique dans 64 cas. Le trajet de ces nerfs etait extremement variable. L'emergence du nerf ilioinguinal au niveau du muscle oblique interne etait situee a 3;30 cm en dedans et a 3;27 cm en dessous de l'epine iliaque anterosuperieure. La terminaison du nerf ilioinguinal etait situee a 2;50 cm en dehors de la ligne mediane et a 1;92 cm au-dessus de la symphyse pubienne. L'emergence du nerf iliohypogastrique au niveau du muscle oblique interne etait situee a 2;30 cm en dedans et a 1;20 cm en dessous de l'epine iliaque antero-superieure. La terminaison du nerf iliohypogastrique etait situee a 3;10 cm en dehors de la ligne mediane et a 4;80 cm au-dessus de la symphyse pubienne. Conclusion : Les incisions chirurgicales faites dans la region hypogastrique; au-dessous de la ligne biiliaque comportent un risque eleve de lesion des nerfs ilioinguinal et iliohypogastrique