[Urachal cyst: contribution of ultrasound (about a case at Sourou Sanou Sobo-Dioulasso university hospital)]. / Kyste de l'ouraque: apport de l'echographie (a propos d'un cas au centre hospitalier universitaire Sourou Sanou Bobo-Dioulasso).

Urachal cyst is difficult to diagnose and is a rare malformation and the authors report a case in a 10-month old boy. The malformation was associated with posterior urethral valve and simple surgical treatment was successful.The authors emphasize the contribution of perineal ultrasound in the diagnosis of associated posterior urethral valves.

Le kyste de l'ouraque est de diagnostic difficile et constitue une malformation rare dont les auteurs rapportent un cas chez un garçon de 10 mois. La malformation était associée à une valve de l'urètre postérieur et sa cure chirurgicale très simple a été couronnée de succès.Ils insistent sur l'apport de l'échographie par voie périnéale dans le diagnostic associé des valves de l'urètre postérieur.

[Osseus age of the black children of Benin. A population study of 600 children aged from 9 to 18 years and living in Cotonou]. / Age osseux du noir béninois. A propos de 600 enfants âgés de 9 à 18 ans et résidant à Cotonou.

PURPOSE: The purpose of this work is to study the skeleton maturation in the black population of Benin by means of Tanner Whitehouse method (TW2) in comparison with the populations of the developed countries. MATERIAL AND METHODS: The study was transversal and analytic. It included 297 boys and 303 girls aged from 9 to 18 years. This was conducted from October 2002 to May 2003 in Cotonou City, the economic capital of Benin. The corrected minimum size of the sample was 384 x 1.19. The sampling technique was chancy, multiphasic, stratified and in clusters. Every one of the 13 districts of Cotonou was considered as a stratum. The interpreter of the anteroposterior radiograph of the left wrist and hand was selected after an intra and extra observer test. The data treatment and analysis were performed by the logiciels Epi info and SPSS. The statistical tests used were Khi 2 test and Kappa index. RESULTS: The sample was mainly composed of pupils: 84.16% among the boys, 77.23% among the girls. 91.01% of the parents of the children had a middle standard of living. The skeleton maturation score increased with age in all TW2 methods. With the TW2 20 bone and RUS methods, the mature score was reached at percentile 50 among the boys at 18.5 years and among the girls at 17 years. It was precociously reached at percentile 97 respectively at 14 and 14.3 years among the boys and 12.7 years among the girls. With the Carpal bone method, the age of mature score at percentile 50 was 18.2years among the boys and 17.2 years among the girls. The early maturation was obtained at percentile 97 among the boys and the girls respectively at 13.2 and 12.5 years. DISCUSSION: The skeleton maturation score of the girls in Benin is I to 1.5 years higher than the one of the boys. With the TW2 bone and the RUS methods, the maturation shows a delay of 0.5 to 2.5 years at the percentile 50 and of 1.5 to 2 years at the percentile 97 in relation to the Belgian, British, Chinese, Korean, Japanese, and North American standards. These delays seem to be mainly due to the less favourable socioeconomic conditions in Benin. In the other hand, the more considerable delay of 1 to 4 years with the Carpal bone method remains to be elucidated. CONCLUSION: The osseous age stemming from this work is representative of the middle social stratums of the city backgrounds. It would gain to be completed by a similar work concerning the country backgrounds of Benin.

[Portal vein: variations of its branches (about 32 dissections)]. / Veine porte: mode de division et ses variantes A propos de 32 dissections.

PURPOSE: The aim of this study is to precise the variations of portal vein branches and also to elucidate anatomic basis of partial hepatectomy. MATERIAL AND METHODS: Thirty-two post-mortem specimens, with ages ranged from one day to sixty-five years in both two sexes, were dissected. Latex and Rhodopas were used for visualizing and drawing the portal vein course and its branches. RESULTS: Nine types of different variations of portal vein branches were observed. Most of cases were similar to those previously reported in literature. But four types must be especially noted, because they were not available in literature. DISCUSSION: this study updates the anatomy of portal vein and its tributaries, and also finds out four types of distribution which must be known by surgeons with regards to partial hepatectomy.

[Epidemiology of the severe hip disorders in children in Benin: prospective study of 180 cases over a 7 year period]. / Epidémiologie des coxopathies graves de l'enfant au Bénin: étude prospective de 180 cas sur un période de 7 ans.

PURPOSE OF THE STUDY: In Benin, the etiological diagnosis of serious hip disorders is often difficult and satisfactory epidemiological data are lacking. The purpose of this study was to establish the relative frequencies of pathological conditions leading to serious hip disorders in Benin. MATERIAL AND METHODS: We report 180 cases of severe hip disorders in 170 children hospitalized over a 7-year period from January 1, 1992 through December 31, 1998. The prospective study was based on clinical and conventional radiological findings, laboratory results and clinical course. RESULTS: The annual frequency of new cases was: septic arthritis of the hip 18.8 (73.3%), legg-Calvé-Perthus disease 2.9 cases (11%), aseptic osteoarthritis of the femoral head 2.3 cases (8.9%), superior femoral epiphysiolysis 0.9 cases (3.3%), coxalgia 0.9 cases (3.3%), accounting for 25.7 new cases of serious hip disorders per year. DISCUSSION: Sickle-cell disease or trait (SS or SC hemoglobin) was the cause of aseptic osteonecrosis of the femoral head in 83% of the cases. For the other serious hip disorders, 30% were observed in sickle-cell trait patients and only 2.7% in patients with sickle-cell disease (SS or SC). These rates are similar to those in the general Benin population. CONCLUSION: These data offer a better perception of the causes of serious hip disorders observed in children in Benin. Further studies are needed to obtain precise data by nosological entity. Legg-Calvé-Perthes disease, unknown in Benin up to 1992, now is the second leading cause of severe hip disorders and their sequelae.

[Radiologic morphometry of the hip in Beninese black children]. / Radiomorphométrie de la hanche chez l'enfant noir Béninois.

PURPOSE: The author aims to objectivize simple parameters of normal anatomy of the hip related to age and sex in children as a contribution to interpretation criterions in medical imagery. Materials and methods. He has examined antero-posterior radiographs of 155 normal hips (right: 81; left: 74) among 129 children aged from six months to 16 years (mean age=8.9 years). They were 86 boys and 43 girls (ratio M/F=2). RESULTS: The results are as follow:--the joint space of the hip (JS/H): cranial part (cranial joint space: CJS/H): 5.5 mm +/- 0.5; medial part (medial joint space: MJS/H): 7 mm+/-0.5; --the bony roofingless part of the femoral head (BR/FH): 1-6 years: 1-3 mm; 7-13 years: 4-5 mm; 14-16 years: 6 mm; --the neck shaft angle of the femur (NSA/F); 1-6 years: 150 degrees-140 degrees; 7-16 years: 135 degrees; --the horizontal and the vertical diameters of the femoral head (HD/FH; VD/FH); x being the age of the children, the HD/FH grows according to a linear regression function as Ydh = 2x + 13+/-2 and the VD/FH as Ych = 2x + 18+/-2; --the centre acetabular edge index (CEI): the CEI decreases from 1 to 16 years: medium: 2.75-1.77; maximum: 2.31-1.67; minimum: 3.62-1.91; --the centre-acetabular cartilage index (CCI)): the CCI grows from 1 to 16 years: medium: 0.57-0.70; maximum: 0.62-0.73; minimum: 0.5-0.68. No influence of the side of the hip nor the sex of the children is observed. CONCLUSION: This study brings out exhaustive and original data on the growth velocity of the hip skeleton in children and supplies with criterions of diagnosis according to age in childhood.

[Caustic burns of the esophagus in children: experience at the National Hospital and University Center of Cotonou]. / Les brûlures caustiques de l'oesophage chez l'enfant: expérience du CNHU de Cotonou. A propos de 52 cas.

Fifty-two children (mean age = 4.1 years) were admitted from 1992 to 1997 for an caustic burn of the oesophagus. Caustic ingestions were accidental in children less than 10 years old and mainly suicidal in older children. Burns were due to alkaline (82%), acids (14%), ou insecticide (4%). The ingested product was decanted from its original packing in 88% of cases. Thirty-six patients had an exclusive medical treatment, including a naso-gastric tube in 3. Endoscopic treatment included naso-gastric tube (n = 4) and bouginage (n = 5). An oesophagoplasty using a colonic transplant was performed in 8 children (15%), always after a previous feeding gastrostomy to improve the nutritional status. There was no operative mortality. These results conform with the main points of the literature. They underline the difficulties in the management of patients with caustic burns of the oesophagus and allow to determine preventive measures of this disease in children of Benin.

Les hernies ombilicales etranglees chez l'enfant au CNHU de Cotonou : a propos de 11 cas

L'etranglement herniaire ombilical est repute rarissime en Europe. Il n'en est pas de meme en Afrique noire et au Benin. Les auteurs ont analyse 111 cas de hernies ombilicales etranglees operees en 22 ans chez l'enfant. La moyenne annuelle est de 5 cas. Les hernies ombilicales etranglees chez l'enfant sont aussi nombreuses que les hernies anguinales etranglees. Les enfants de 9 mois a 5 ans ont ete les principales victimes; en particulier les nourrissons de 9 mois a 30 mois qui ont represente 54;96 pour cent des cas. Les hernies de petit volume ont ete les plus nombreuses. Les visceres etrangles (grele; epiploon) ont ete reseques dans 9 cas. La mortalite a ete de 1;80 pour cent. Les auteurs preconisent une intervention chirurgicale prophylactique dans les cas d'engouement herniaires ombilicaux

[The posterior interparieto-peritoneal or retroperitoneal spaces. 2: Pathological x-ray computed tomographic image]. / Les espaces interpariétopéritonéaux postérieurs ou espaces rétropéritonéaux. 2 Partie: Anatomie tomodensitométrique pathologique.

The old reports about the interparieto-peritoneal spaces described particularly the renal space and its environment. The CT scan has modified the in vivo study of the extraperitoneal spaces (E.P.S.) and brought the question of the acquired knowledge up again. An anatomical research was performed in the first part of this study which describes the structures limited between the parietalis fascia and visceral peritoneal fascias. These are the true EPS which the main element is the propria fascia of Sappey (lateroconal fascia) and its anterior and posterior renal double layers. All these lamellar structures limits spaces variably infiltrated with fat tissue: the anterior pararenal space almost virtual, the posterior pararenal space which continues till the Bogros space and the anterior and posterior renal spaces of the renal compartment which the fat continues till the bladder and accompanies the ureter. The second part of this study precises some notions of general topography which are necessary for reading abnormal CT scan images. This part reminds the aortic and arterial general organization of the vertebrates as described by Mackay. It underlines the architectural importance of the three areas so defined: parietal or peripheral, intermediate or mesoblastic genitourinary and deep lateral or digestive endoblastic. These three areas corresponds to the three vascular aortic circles. It emphasized the importance to accept in practice the notion of visceral joining fascia which has been proved in adult people. The longitudinal architecture of the compartments is precise with respect to their appartenance to one among the three arterial arches of Mackay. What the anatomy suggest, the pathology can prove. Several pathological processes are studied on CT scan: large hemorrhagic or necrotic collections in acute pancreatitis, abnormalities or diseases of renal or adrenal compartments, extraperitoneal mesenchymomas, diseases of the psoas compartment. All these observations are analysed in order to explain anatomical and CT scan findings. This study refers not only to the oldest researches which are still valuable but also to the most recent controversies. All the questions are not solved using the clearest schemes.

[The posterior interparietoperitoneal spaces or retroperitoneal spaces. 1: Normal topographic anatomy]. / Les espaces interpariéto-péritonéaux postérieurs ou espaces rétropéritonéaux. 1re partie: Anatomie topographique normale.

The posterior spaces between the wall and peritoneum or extraperitoneal spaces are located between the visceral retrocolic and retro-duodenopancreatic fascias anteriorly and the parietalis fascia posteriorly. They were studied using an anatomic and computed tomographic comparison. The propria fascia (lateroconal fascia) divided into the anterior and posterior layers of the perirenal fascia. The fascias delimitate two anterior and posterior pararenal spaces around the kidney compartment and two anterior and posterior perirenal spaces in the compartment itself. These spaces extended above and below the renal compartment from the diaphragm to the pelvis. These large spaces composed of fat and organs can assume the guided migration of pathologic processes or their spread according to the importance of the fascias barriers. They below to the genito-urinary region. The extraperitoneal spaces are related anteriorly to the retroperitoneal alimentary organs: duodenum, pancreas, ascending and descending colon depending of the alimentary region. They are related posteriorly with the abdominal wall and its own fat. The individuality and the interdependance of these three territories (alimentary, genito-urinary and abdominal wall) and their consequences for pathologic CT scan imaging will be discussed in the second part of this paper.

[Vascularization and innervation of the sternocleidomastoid muscle and its cutaneous covering: anatomical bases for its use in plastic surgery]. / Vascularisation et innervation du muscle sterno-cléido-mastoïdien et de son revêtement cutané: bases anatomiques de son utilisation en chirurgie plastique.

The commonest use of the sternocleido-mastoid muscle (SCM) and its cutaneous recovering in plastic surgery remains the rotation flap. With the improvement in microsurgery, it is tempting to anticipate the free transfer of the muscle with vascular and nervous anastomosis. 40 SCM muscles from fresh human adult cadavers were studied. The authors stress the richness of the arterial blood supply of the upper portion of the muscle. They give precise details about its venous drainage, the arterial anastomosis, the blood supply of the superficial cutaneous planes and the motor and sensory innervation.

[Vascular problems in gastric esophagoplasty after esophagectomy or circular pharyngolaryngectomy]. / Etude des problèmes vasculaires dans les oesophagoplasties gastriques après oesophagectomie ou pharyngolaryngectomie circulaire.

Gastric oesophagoplasty (GOP) after total oesophagectomy or circular pharyngolaryngectomy is complicated by an average anastomotic breakdown or fistula rate of 15%, and a stenosis rate of 8%. Ischemia related to the actual procedure itself undoubtedly plays a role in the production of such complications in spite of the rich vascular supply to the stomach. The authors report the results of an anatomical study involving 24 stomachs from non-embalmed adults studied by various forms of arteriography depending in the GOP technique employed. For healthy normotensive gastric arteries, they demonstrate the principal elements likely to influence the vascularisation of the graft and propose a provisional vascular score for ischemia. Based on this, they discuss the vascular risks associated with GOP techniques in general.

[Comparative study of vascularization of the stomach after hyperselective vagotomy and anterior seromyotomy]. / Etude comparée de la vascularisation de l'estomac après vagotomie hypersélective et séromyotomie antérieure.

Based on a Micropaque arteriography study of 21 stomachs from non-embalmed adults, the authors compare the ischemic consequences of highly selective vagotomy (HSV) with those of anterior seromyotomy (ASM) combined with posterior trunk vagotomy. HSV inevitably produced an avascular band 2-4 cm wide in the lesser curve region. ASM, to be total and effective, needs to produce hemostasis of the submucosal plexus thereby also producing ischemia of the denuded mucososubmucosal band. It is however possible to avoid the submocosal plexus by remaining more superficial; however, it is then necessary to combine an additional neurotomy otherwise the procedure is likely to fail. In any event, the partial ischemia associated with ASM is much less serious than that noted after HSV.

Arterial vascularization of the operated stomach: highly selective vagotomy, anterior lesser curve seromyotomy, esophageal replacement by transposed stomach after esophagectomy or circular pharyngolaryngectomy.

The rich vascularisation of the stomach is well known and the remarkable tolerance of the organ to vascular ligatures has been emphasised. However, some clinical observations as well as more and more detailed anatomical studies suggest some modification of this classical concept, especially when operating on the viscus. The aim of this work was to evaluate particularly the importance of parietal ischemia which follows hyperselective vagotomy and the more recent anterior seromyotomy, on the one hand, and the gastrolysis that precedes gastro-esophagoplasty after esophagectomy or circular pharyngolaryngectomy on the other hand. The stomachs of 40 unembalmed adult cadavers were studied by angiography in various ways, according to the operation which was being considered. The findings indicated that hyperselective vagotomy caused an avascular band 2 cm wide along that part of the lesser curve affected by the surgical intervention, and that anterior seromyotomy (allowing for some technical artifacts) caused almost no parietal ischemia, and lastly, that the ischemia from gastro-esophagoplasty varied according to the technique used. Useful conclusions, supported by numerous illustrations, will allow the surgeon to define better the vascular requirements when choosing the procedure to be used, taking account of the clinical situation.

[Pharyngoesophageal reconstruction using a vascularized free jejunal graft. Indications--technique and surveillance. Report of 90 cases]. / La reconstruction pharyngo-oesophagienne par transplant libre jéjunal revascularisé. Indications--techniques et surveillance. A propos de 90 observations.

Several procedures have been proposed for pharyngoesophageal reconstruction. The use of a revascularized free jejunal graft currently appears to be a method of choice for anatomical, physiological and technical reasons. The authors currently look back on a series of 90 patients having received a revascularized free jejunal graft between 1978 and 1989 inclusive. The indications predominantly include cancer of the pharynx invading the posterior wall and preserving the cervical esophagus, requiring total circular pharyngolaryngectomy (77 cases). Some benign lesions involve reoperated patients (13 cases). The technique for obtaining the jejunal graft is accurately codified: use of the 3rd jejunal loop in isoperistaltic conditions, refrigeration during the period of ischemia, revascularization by the cervical vessels. If a salvage operation is needed, it is necessary to prepare a saphenous venous graft at the beginning of the operation (3 cases). These grafts must be observed daily. Early negative signs include unexplained epistaxis, blood in the saliva, cervical skin suffering. Emergency fiberscopy must be performed with a bronchoscope or a rhinofiberscope. In case of suffering or necrosis of the graft, the patient must be reoperated immediately and a second free jejunal graft must be placed. The absence of postoperative mortality, low morbidity and good functional results obtained in the series are convincing reasons for using this procedure.