[Prognosis of post-operative digestive fistulas in Chu de Yopougon: Abidjan/Cote d'Ivoire]. / Pronostic des fistules digestives post-operatoires au Chu de Yopougon : Abidjan/Cote d'Ivoire.

OBJECTIVE: Because of the difficulties to manage the post-operative digestive fistulas (FDPO) and their disappointing results, the authors led this survey. It's objective is to identify the prognosis factors in order to optimize their management and improve their prognosis. PATIENTS AND METHOD: It is a retrospective survey during 12 years, from January 1992 to December 2004 in the general and digestive surgery adult service of CHU Yopougon. It included 86 files of patients aged of 15 years at least presenting a FDPO. RESULTS: The middle age was of 36.8 years. The death rate was 29.06%. It rose with age. The risk of death was multiplied by 5.54 over age of 55 years (OR = 5.54 and p = 0.012). The number of death rose meaningfully with the length of the diagnostic delay (p = 0.016 for OR1 = 1.64 and OR2 = 8.94. The death rate was raised more in the exposed fistulas that in the controlled fistulas (87% against 45%). In 50% of the cases the death occurred when the debit was superior or equal to 500 cc daily. Among the patients submitted to the medical treatment 69.70% had a spontaneous closing of their fistula in a middle delay of 27.18 days for extremes varying between 13 and 47 days. CONCLUSION: The affection is very serious considering it's death rate. A precocious diagnosis and a fast and adapted management should permit to reduce this higher mortality.

Erysipele : aspects epidemiologiques; cliniques et complications au centre de Dermatologie du CHU de Treichville a Abidjan (Cote d'Ivoire) sur 10 ans (1992-2002)

Notre etude retrospective; qui a porte sur 10 ans; a permis de recenser 350 cas d'erysipele ce qui nous donne une frequence de 1;4pour cent. L'erysipele est donc une dermatose relativement frequente. II predomine chez le sujet de sexe masculin avec un sex-ratio (IVE) de 1;3. L'age moyen des patients est de 37 ans.Les patients affectes ont un niveau socio-economique faible. Il existe une recrudescence de la maladie pendant la saison seche c'est-a-dire lors des grandes chaleurs. Les portes d'entree sont surtout des effractions cutanees sous formes d'intertrigos inter orteils (22;3pour cent) et d'ulceres de jambe (18;8pour cent). Les facteurs locoregionaux sont domines par les varices (3;7pour cent) et les facteurs generaux par le diabete (3;5pour cent). La localisation la plus frequente est la jambe. Les signes cliniques sont identiques a ceux decrits par la litteraire c'est-a-dire la grosse jambe rouge; douloureuse; febrile dans 99;4pour cent des cas. On peut observer parfois des vesicules ou des bulles; ou des purpuras. Ce placard inflammatoire est constamment accompagne d'ADP satellites sensibles. Le syndrome infectieux qui existe dans 99;1pour cent des cas reste le signe precurseur. L'etat general est conserve dans la quasi-totalite des cas. La fasciite necrosante est de loin la premiere complication immediate (94;6pour cent) et sa survenue est liee a la prise d'anti-inflammatoires non steroidiens (AINS). 1es complications a long terme sont dominees par les recidives (83;6pour cent) qui a la longue sont generatrices d'elephantiasis. Les examens paracliniques; qui ne sont pas indispensables; ont permis de confirmer que le streptocoque A est l'agent etiologique principal comme partout ailleurs

[Experience with preperitoneal hernioplasty using Stoppa's procedures in the Ivory Coast]. / Expérience de la hernioplastie prépéritonéale selon le procédé de Stoppa en Côte-d'Ivoire.

OBJECTIVE: The treatment of groin hernias with a high risk of recurrence often provides therapeutic difficulties in Africa for fear of using mesh due to the potential risk of sepsis. The aim of this retrospective study was to emphasize the simplicity and efficacy of Stoppa's technique. PATIENTS AND METHODS: From 1994 to 1999, 128 patients with 239 groin hernias underwent hernioplasty with Stoppa's technique. They were all men with a mean age of 54 +/- 8 years. They were classified in stages III and IV (46.8%, n = 60) of Nyhus. One hundred and eleven patients (86.7%) had bilateral hernias and 64 had a factor of recurrence (50%). RESULTS: Mean operating time was 150 +/- 42 min (50-240 min). Follow-up ranged from 6 months to 6 years, with a mean time of 26 months. Eighteen patients were lost to follow-up. The mortality rate was 0.8% (n = 1). The morbidity rate was 18.7% (n = 24) with five hematomas (3.9%), 11 seromas (8.6%), one parietal infection (0.8%) and one recurrence (0.8%). CONCLUSION: These results suggest that Stoppa's technique is efficient and technically feasible in our conditions and has to be performed more frequently.