[Intensive care management of patients with severe head traumatism in Benin from 1998 to 2002]. / Traumatismes crâniens graves en réanimation au Bénin de 1998 à 2002.

OBJECTIVE: To study in Cotonou (Benin) in tropical environment, the specific problems of severe head injury. STUDY DESIGN: Five years retrospective study in Cotonou University National and Teaching Hospital. PATIENTS AND METHODS: All patients admitted with severe head injury between January 1998 and December 2002 were included. The following parameters were studied: age, sex, traumatism cause, temperature, blood pressure, Glasgow coma scale. RESULTS: Two Hundred thirty six patients (mean age 32 +/- 18 years) essentially men, were admitted. The cause of the injury was road traffic accidents in 86% of cases. Prehospital medicalisation was achieved in only 9% of cases. A head CT-scan was performed in 5% of the cases. Respiratory resuscitation essentially used the association intubation and oxygenation (59%), 19% of the patients were ventilated and 21% were sedated. Mortality was closely related to the initial Glasgow coma scale score (GCS): GCS 3-4 = 97%; GCS 5-6 = 72% GCS 7-8 = 36%. Overall mortality was 70%. CONCLUSION: Severe head injury is a major cause of morbidity and mortality in developing countries. Limited access to highly specialised care explain a high mortality rate. An active policy of prevention from administrative authorities and a greater effectiveness of medical management may improve outcome.

[Case report of acute intoxication from intravenous injection of petroleum] . / A propos d'un cas d'intoxication aiguë par injection intraveineuse directe de pétrole.

A 18-year-old patient injected intravenously 2.5 mL of paraffin oil into the right upper limb. It caused a local thrombophlebitis with a slow evolution. A collapsus occurred on the sixth day. The authors obtained a clinical recovery of the limb after heparine and oral anticoagulation.

[A case of acute pyrimethamine poisoning]. / A propos d'un cas d'intoxication aiguë à la pyriméthamine.

Intoxication by pyrimethamine is rare compare to these of patients who ingest a massive dose of amino-4-quinoleine. Clinic manifestations can be delayed and they are specially based on haematologic disorder as shown by literature data. Others organs can be concerned. The authors would like to present the case of a patient with a severe pancytopenia accompanied with: ocular blow like hyperhaemia of conjunctiva then iris siderosis. skin attack as Gunther's disease. Etiologic treatment by folinic acid is the only deduction. Recovery is complete.

Prise en charge des malformations chirurgicales digestives de l'enfant dans le service polyvalent d'anesthési-réanimation

Les malformations digestives de l'enfant sont souvent des urgences chirugicales a la naissance avec une gravite preoccupante dans les suites operatoires. Dans le but d'evaluer la frequence et le pronostic de ces malformations; les auteurs analysent les observations de 38 enfants recus en 5 ans dans le service polyvalent d'anesthesie reanimation du Centre National Hospitalier et Universitaire de Cotonou. Les malformations congenitales sont essentiellement des imperforations anales; des atresies et stenoses digestives; des omphaloceles et des maladies de Hirshprung. Elles representent 1;8 pour cent des admissions du service et 5 pour cent des urgences chirurgicales digestives. Excepte; tous les enfants sont operes le jour de leur admission. Les suites operatoires ent ete marquees par: 22 cas de deces soit 57;9 pour cent et 7 cas de complications a type de peritonites; fistules et occlusions. Le pronostic est lie a la specificite du terrain du nouveau-ne et au retard de diagnostic

La tuberculose peritoneale de l'adulte au C.H.N.U. de Cotonou : aspects epidemiologiques; cliniques et evolutifs : a propos de 28 cas

L'etude porte sur 28 cas de tuberculose peritoneale observes chez l'adulte au C.H.N.U. de Cotonou. Cette maladie; dont la prevalence hospitaliere est estimee a 1 pour cent; atteint les grands adolescents et les adultes jeunes de conditions socio-economiques modestes. Les formes cliniques sont dominees par la peritonite tuberculeuse chronique asciatique (17 cas); suivie de la tuberculose peritoneale subaigue (9 cas); les formes aigues pseudo chirgicales sont rares (2 cas). Le diagnostic se fonde essentiellement sur le contexte clinique; les caracteres du liquide d'ascite; le test therapeutique et les donnees de la laparatomie ou de la laparoscopie. L'evolution sous traitement specifique est toujours favorable. Enfin; sont evoquees les raisons de la persitance de l'endemie tuberculeuse

[Version by internal maneuvers: alternative to cesarean section under precarious conditions. The experience of the University Clinic of Gynecology and Obstetrics]. / La version par manoeuvres internes: alternative à une opération césarienne dans des conditions précaires. Expérience de la CUGO.

Obstetrics practised in African University Hospitals is beset with specific constraints. The emergency admission of a woman whose fetus is dead or severely compromised, after an extended labor and an obvious ovular infection, leads to fear an hysterotomy as well as an hysterectomy. The authors specify, under their work conditions, the indications of internal version maneuvers, from 50 cases collected in one year. The fetal prognosis is not taken into account since it concerns dead or very threatened children. As for the maternal prognosis, it is excellent since the average stay is of 48 hours and no severe infection developed, which is not the case for caesarean sections performed under the same circumstances. If a maternal death must be deplored, it concerned a placenta praevia in a distressing conjunction of circumstances since the blood bank was out of blood.