[Closed-heart mitral commissurotomy: our experience at the Main Hospital in Dakar]. / La commissurotomie mitrale à coeur fermé: notre expérience à l'Hôpital Principal de Dakar.

Confronted with difficulties of medical evacuation to cardiovascular surgical hospitals in Europe, the authors decided to bring up to date closed heart mitral commissurotomy. The aim of the study was to estimate possibility to select patients, to operate them safety to appreciate the results in medium and short time and the intervention's cost. 8 women and 7 men had a closed heart mitral commissurotomy from June 1995 to January 1997 in Dakar Principal Hospital; inclusion criteria were a symptomatic mitral stenosis with area less 1.5 cm2; exclusion criteria were an other valvulopathy, a Wilkin score above 8, a severe pulmonary arterial hypertension, an auricular thrombosis. One patient died on the forth day; a completely regressive hemiplegia was the only complication; 14 patients were clinically very improved: the average mitral area by planimetry form 0.89 cm2 +/- 0.15 became 1.64 cm2 +/- 0.33 and by Hatle formula from 0.82 cm2 +/- 0.12 to 1.71 cm2 +/- 0.37; the intervention cost was in second class 1,000,000 F CFA, in third class 820,000 F CFA. This study shows closed mitral commissurotomy can be realised in an african hospital as Dakar Principal Hospital; short and medium results are good; African surgeons must go on studying this surgical technic.

[Abdominal gunshot wounds. Ballistic data and practical management]. / Plaies de l'abdomen par balle. Données balistiques et conduite pratique.

The mortality from abdominal gunshot wounds remains high, either in civilian or military cases. The severity factors of these wounds include bullet calibre and energy transfer of the missile. This paper studies some of the ballistics features of abdominal gunshot wounds. Practical guidelines are inferred concerning diagnosis and treatment of these wounds.

[Post-partum malignant amebic colitis. Apropos of a case]. / Amibiase colique maligne du post-partum. A propos d'un cas.

A 26-year old female developed acute fulminant amoebic colitis during the post-partum period, successfully managed by subtotal colonic resection without anastomosis. Fulminant transmural amoebic colitis is a rare life-threatening complication of invasive bowel amebiasis. Pregnancy, delivery, diabetes mellitus and immunodeficiency are the main risk factors. At pathologic examination, bowel wall necrosis can be seen with amoebae present in the lumen of capillary vessels. The diagnosis of amoebic colonic perforation is difficult, especially in a non-endemic area. Conservative surgical management is required in non-perforated forms. If perforated, the bowel must be resected, limited to macroscopic lesions.

[Simultaneous hepatic cholangiocarcinoma and bone fibrosarcoma 45 years after ingestion of Thorotrast]. / Cholangiocarcinome hépatique et fibrosarcome osseux synchrones 45 ans après injection de Thorotrast.

This case of a 63 year old man reports the simultaneous development of hepatic cholangiocarcinoma and fibrosarcoma of the sacrum 45 years after the systemic injection of Thorotrast. The characteristic radiologic aspect was an important criteria for diagnosis. Biopsies have confirmed the histology of both tumors. We describe the way to thorotrastosis diagnosis and characteristic malignant tumors, especially cholangiocarcinoma, induced by Thorotrast.

[Treatment of bilateral inguinal hernia by subperitoneal prosthetic parietoplasty. Value of PTFE]. / Cure de hernie inguinale bilatérale par pariétoplastie prothétique sous péritonéale. Intérêt du PTFE.

This retrospective study reviews 211 patients having sustained a bilateral groin hernia repair during a 3 year period. The procedure was the same for all the patients: via a Pfannensteil approach, a pre peritoneal prosthetic repair is performed, using two ePTFE patches, after resection of the hernial sacs and closure of the parietal gaps. The mean follow up was 2 years. During the post operative course, thirty seven of 211 patients sustained 10 local complications, 9 urethral catheter related complications and 11 residual pain. No prostheses infection or testicular atrophy was observed. Nine patients had recurrences (2.2% of 422 repairs). All the recurrences were due to incorrect technique, eight were successfully re operated on--Expanded PTFE is a reliable prosthetic material, easy to handle and well adapted to preperitioneal hernia repair.

[Two cases of cystic adventitial disease of the popliteal artery. Current diagnostic approach]. / Deux cas de kystes adventiciels de l'artère poplitée. Approche diagnostique actuelle.

The authors report two cases of cystic adventitial disease of the popliteal artery. Both patients complained of calf claudication and presented a thrombosis of the popliteal artery. In one case, magnetic resonance imaging exhibited a specific preoperative diagnosis. In both cases, at least one communication between the cysts and the capsule of the knee joint was demonstrated, supporting the congenital hypothesis of the disease. The two cases have been treated by vein graft replacement of the occluded popliteal arteries. Both patients have remained asymptomatic and the two grafts have remained patent during the ninth and twelfth month follow-up periods.

[The impossible compromise. Apropos of a paper on ballistic injuries by Messrs. Cooper and Ryan]. / Le compromis impossible. A propos d'un article de balistique lésionnelle de MM. Cooper et Ryan.

This paper analyzes a publication of wound ballistic from MM. Cooper and Ryan published in British Journal of Surgery 1990, vol. 77 June pp. 606-610 which call "Interaction of penetrating missiles with tissues: some common misapprehensions and implications for wound management". MM. Cooper and Ryan describe interaction of penetrating missiles with tissues, they denounce that they call common misapprehensions in wound ballistic and they try to reconcile engineers works and clinical observations. As a result of this synthesis, a management of war injuries is recommended. Authors of this present paper do a methodical analysis of the British publication and denounce: 1. the experimental method and the "energy-transfer" concept; 2. two contradictories and irreconcilable doctrines promulgated in wound ballistic world which are in one hand supporters of 5.56 bullets shock wave giving distant wounds and iatrogenic mutilations, on the other hand, supporter of wounds treatment without any need to know the weapon; 3. differences between wounds of war and peacetime is sometime more theoretical than real and may give the place to the concept of circumstances surgery.

[Perineal anorectal wounds in war surgery]. / Plaies anorectales périnéales en pratique de guerre.

Wounds of perineal rectum represent an emergency by reason of immediate and secondary seriousness, their ultimate sequelas (15%). From their experience, review of the literature, the authors define a surgical attitude available for civilian injuries: terminal colostomy, large drainage, cautious surgical treatment of rectal injury.

[Vascular complications of fractures of the pelvis]. / Les complications vasculaires des fractures du bassin.

Fifteen cases of severe fractures of the pelvis associated with vascular complications are reviewed. The operational strategy remains controversial when faced with these life threatening traumatic lesions. The chief cause of mortality of these fractures is subperitoneal or retroperitoneal expanding hematoma, the natural course and evolution of which are presently well known and better explored thanks to modern imaging technology. Early-phase intensive care and intervention radiology are partly responsible for a change in the immediate therapeutic attitude. Nonetheless, in hemorrhagic poly-traumatic patients, surgical treatment is still required and remains a method non devoid of pitfalls.

[Malignant pheochromocytoma]. / Phéochromocytome malin.

A case of metastatic malignant pheochromocytoma which was operated on is discussed. The benefits derived from the most recent localizing techniques such as CT scan and MIBG scintigraphic scanning are stressed. In the case presented these enabled the adrenal tumor to be detected but also demonstrated the presence of a costal metastasis and two metastases in the axial skeleton. A therapeutic trial with MIBG at doses of 100 mCi per treatment only enabled a survival of a little more than one year to be achieved.

[Bilateral popliteal artery aneurysm revealing an entrapment]. / Anévrysme poplité bilatéral révélateur d'un piège.

Popliteal entrapment syndrome is not so rare if usually researched by clinical examination. But it is very unusual to find a bilateral aneurysm when you first examine your patient. One of them was complicated by a rupture. The surgical management with bilateral venous grafts is described.