[Urogenital fistulas: etiopathogenic and therapeutic aspects at the University Hospital Center of Brazzaville]. / Les fistules urogenitales: aspects ethiopathogeniques et therapeutiques au CHU du Brazzaville.

INTRODUCTION: The urogenital fistulas continue to be a dangerous complication of the childbirths dystociques in Africa and especially to Congo. OBJECTIVES: To analyze the étiopathogénic and therapeutic aspects of the urogenital fistulas in order to suggest preventive measures. SICK AND METHODS: It is about a retrospective survey achieved in the service of urology of the univertery hospital center of Brazzaville of January 2001 to December 2005 concerning 34 patients hospitalized for urogenital fistulas. The étiopathogéniques and therapeutic aspects have been analyzed. RESULTS: The urogenital fistulas represent about 2,7% of the hospitalizations in urology. The middle age is of 31 years (17 - 65 years). 28 (82%) are of obstetric origin with 11 Caesareans and 17 childbirths dystociques. 6 are especially of surgical origin after hysterectomy. 28 patients have been operated among which 2 have been taken. The different surgical techniques were the following: 20 ways transvésicales, 3 Chassar Moirs, 2 LEGUEU, 3 Martius and 2 vaginal ways with Picot Couvelaire. The anatomical shapes were: 29 fistulas vésicovaginales, 1 vésico uterine, 3 vesico vaginorectal and 1 urétérovaginale. After surgery, we got 25 anatomical closings of which 1 with incontinence. 3 recidivisms have been observed: 2 have been reoperate of which 1 success and 1 failure. The 3rd being lost of view. To the total we got 25 successes (89,2%). CONCLUSION: The urogenital fistulas remain frequent with a predominance of the obstetric reasons. The recidivisms are possible from where the necessity of a mastery of the surgical techniques.

[A case of isolated tuberculosis of the appendix at the University Hospital Center in Brazzaville, Congo]. / Une observation de tuberculose isolée de l'appendice au Centre Hospitalier et Universitaire de Brazzaville.

Since the outbreak of human immunodeficiency virus (HIV) infection, extrapulmonary tuberculosis has become increasingly frequent in developing countries. The purpose of this report is to describe a case of isolated tuberculosis of the appendix diagnosed following generalized peritonitis in a 53-year-old man. The appendix is the least frequent gastrointestinal location of isolated tuberculosis. Diagnosis was achieved by histopathological examination of the appendix immersed in formalin 10% after appendectomy. Paraffin-embedded histological sections stained with hematoxylin-eosin (HE) displayed caseofollicular lesions characteristic of infection by Koch bacillus. Outcome was favourable with a 9-month regimen of antituberculosis treatment according to the protocol of the World Health Organization (WHO).

[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.

[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.

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

Une observation de tuberculose isolee de l'appendice au centre hospitalier et universitaire de Brazzaville

La tuberculose extrapulmonaire est; dans les pays en voie de developpement; de plus en plus frequente avec l'avenement de l'infection au virus de l'immunodeficience humaine (VIH). Les auteurs rapportent l'observation d'un homme de 53 ans immunocompetent ayant presente une tuberculose isolee de l'appendice revelee par une peritonite generalisee. Cette atteinte isolee de l'appendice est la moins frequente parmi les localisations viscerales digestives. Le diagnostic anatomo-pathologique etait fait sur la piece d'appendicectomie immergee dans du formol a 10

[Voluminous right scrotal inguinal hernia: interest in treatment of the hernia without tension according to Lischtenstein technique--an observation]. / Volumineuse hernie inguino scrotale droite: interet du traitement sans tension des hernies de l'aine selon la technique de Lichtenstein--une observation.

We report the observation of right scrotal ingino hernia (tropical hernia) on a young subject of 31-years-old. Tropical hernia have become rare and are faced with a therapeutic taking charge of problem. This tropical hernia has been treated by the settlement of a prosthesis without tension according to Lichtenstein technic. It's about a simple technic of rapid realisation which gives good results and a long term recurrence rate, under 1%.

[Results of the surgical treatment of hemorrhoids according to Milligan and Morgan technique - report of 56 cases]. / Resultats du traitement chirurgical de la maladie hemorroidaire belon la technique de Milligan et Morgan--a propos de 56 cas.

AIM OF THE STUDY: To study the results of the surgical treatment of haemorrhoid disease according to Milligan and Morgan technique. MATERIAL AND METHOD: It is about a retrospective study in the unit of the digestive surgery of the teaching hospital of Braszaville. From March 1992 to february 2002, 56 patients who had hemorrhoid disease have undergone a pedicular hémorroïdectomy of Milligan and Morgan type. The diagnosis of the hemorrhoid has been established from the clinical and endoscopic elements in the search of associated lesions. RESULTS: There were 36 men (64.28%) and 20 women (35.72). The average age of our patients was 36 years old (extremes: 18 and 62 years old). Post surgical effects have been simple in 52 cases and complicated in 4 cases. 2 cases of anal oozing with an occasional incontinence of having wind and 2 cases of post surgical stenosis. No death has bees noticed. The average time spent in hospital was five days. (Extremes: 6 and 11 days). There was no case of surgical resumption. At the functional level was the disappearance of pains, hemorrhoid and prolapse. CONCLUSION: The pedicular haemorrhoidectomy of Milligan and Morgan is a well codified surgery where good results are provided.

[Systematization of proper lymphatic vessels of the diaphragm]. / Systematisation des voies lymphatiques propres du diaphragme.

The aim of this study was to demonstrate lymphatic vessels of the diaphragm, its connexions with mediastinum and abdominal cavity in order to better understand propagation of neoplasic or infectious processes. Diaphragmatic pleura of 30 adult cadavers and 12 fetuses, unscathed of any cardiopulmonary pathology, were injected with modified Gerota's medium to permit lymph vessels and nodes to be visualized and then dissected. Each stage of dissection was described and photographed. Diaphragmatic lymph vessels, their connexions with diaphragmatic lymph nodes, mediastinum and abdominal cavity have been so demonstrated. Diaphragm appear to be a very important lymphatic center, with its own lymphatic vessels, with connexions to the mediastinum and abdominal cavity. The propagation of infectious or neoplasic processes are so better understood.

[Left colic cancer at Brazzaville Teaching Hospital. Results from surgical treatment]. / Le cancer du colon gauche au CHU de Brazzaville. Resultats du traitement chirurgical.

AIMS: to examine the results from the surgical treatment of left colic cancer. PATIENTS AND METHOD: It is about a retrospective study which has been undertaken in the digestive surgical unit of Brazzaville teaching hospital from January 1999 to October 2001. 18 patients who had a left colic cancer have undergone operated. RESULTS: Our series included 18 men (66.67%) and 9 femmes (33.33%). The sex ratio was 2. The surgical after effects were simple in 63% (n=18) cases and complicated in 37% (n=10) cases, one case parietal suppuration. The average time of hospitalization was about 10 days.

Lymphatic drainage of the diaphragmatic pleura to the peritracheobronchial lymph nodes.

Non-small cell lung cancer invading the visceral pleura is characterized by a particular richness of mediastinal lymph node (LN) metastases. This may be due to subpleural lymphatic drainage of tumor cells. The aim of this study was to determine mediastinal LN lymphatic drainage from the diaphragmatic pleura. Subpleural lymphatics of 30 adult cadavers and 12 fetuses were injected with a modified Gerota's medium to permit lymph vessels and nodes to be visualized and then dissected. Each stage of the dissection was described and photographed. In 32 cadavers mediastinal visceral LN chains were injected, of which 29 originated from the mediolateral portion of the diaphragm. On the right, injections (n=16) demonstrated lymph vessels (n=20) ascending directly along the inferior pulmonary ligaments (n=8) or after having encircled the inferior vena cava (n=8), and lymph vessels passing between the pulmonary veins (n=4); all these lymphatics were connected to the intertracheobronchial nodes and some ascended along the tracheobronchial LN chains in the upper mediastinum. On the left, injections (n=13) demonstrated lymph vessels (n=16) ascending along the inferior pulmonary ligament (n=5) or along the esophagus (n=11) and connecting to the intertracheobronchial nodes, some of which ascended further in the upper mediastinum (left paratracheobronchial LN chain). These mediastinal LN chains are the same as those that receive lymph from the pulmonary segments. Lymphatic drainage of the diaphragmatic pleura may add to that of the lung involved in cancer and potentially increases lymphatic spread of tumor cells.