Les cancers du sein masculin à Niamey

Moins frequent que chez la femme; le cancer du sein existe aussi chez l'homme. A partir d'une serie hospitaliere a Niamey au Niger; nous avons entrepris une etude retrospective afin d'en analyser les particularites epidemiologiques cliniques et therapeutiques. Durant la periode d'etudes (1992-2006); nous avons collige 18 cas microscopiquement confirmes. La majorite des malades etaient d'origine rurale. Ils se sont presentes a des stades avances : T3 et T4. Toutes les malades ont ete operees; seules 4 parmi elles ont eu un traitement complementaire adjuvant. Le carcinome canalaire infiltrant a ete le type histologique le plus frequent (55;5). L'evolution n'a pu etre evaluer car tous les malades etaient perdues de vue 6 mois apres l'acte operatoire

[Appendicitis and advanced pregnancy. Apropos of 3 cases in the National Hospital of Niamey, Niger]. / Appendicite et grossesse avancée: à propos de 3 cas à l'Hôpital national de Niamey, Niger.

Acute appendicitis during pregnancy is uncommon but a serious situation even in developed countries with imaging and laboratories' poor means. Failure to diagnose this disease during advanced pregnancy exposes foetus and mother to serious complications. In this atypical clinical picture associated with non-significant biologic sign only using sonogram can help to early diagnosis. In our developing countries where obstetrical exam was performed by paramedical or general doctor, in doubt the patient must be transferred in medical centre with a capacity of imaging or laboratory exams. Surgical treatment must be undertaken after surgeon, obstetrician, and other physicians's consultation. Antibiotic and tocolytic treatments are urgent. In this study, all babies were lost by premature labour occurred after surgery.

[Application of the Unmet Obstetrical Needs method in the III neighborhood of Niamey, Niger (1999)]. / Application de la méthode des besoins obstétricaux non couverts dans la commune III de Niamey, Niger (année 1999).

West Africa has probably the highest levels of maternal mortality in the world. A new method has been developed by the Institute of Tropical Medicine of Antwerp (Belgium) that gives an estimate of the Uncovered Obstetrical Need. This technique tested in different Western African countries has been now evaluated also in an urban medical district in Niamey, capital of Niger, for the year 1999. The uncovered obstetrical need has been estimated at 15 major Obstetrical Interventions for this period; this means that 15 pregnant women didn't undergo a major surgical intervention necessary to save their life and that they probably died because of this non-intervention. We met quite a lot of problems with this new method: (i) the first problem is related to the difficulty to obtain correct demographic information: it is very difficult to estimate population growth in urban african areas, present population and number of attended births. (ii) The second difficulty came from sociocultural habits: primipare women in Niger go back to their family to deliver (and the place where their family lives is not necessarily the same as the place where they stay with their husband); it is quite possible that a number of primipare women needing a major surgical intervention didn't undergo this intervention because they delivered in their home village (and perhaps died there). (iii) At last, the estimation of a reference rate (calculated at 0.9% for Niger) implies that all women needing a major obstetrical intervention in Niamey, and having a theoretical easy access to medical infrastructures (first line as second line hospitals) present themselves when having a major obstetrical problem. This is probably "wishful thinking". The interest of this new method lies in the fact that it is a cheap technique and easy to put into practice ... provided that one disposes of medical infrastructures that collect correctly all necessary medical information.

Intrathoracic blood supply of the left vagus and recurrent laryngeal nerves.

The arteries and veins of the left vagus (VN) and left recurrent laryngeal (RLN) nerves from the thoracic inlet to the subaortic region are described following vascular casting with red colored latex in 6 adult fresh non-embalmed cadavers. In all specimens the anterior bronchoesophageal artery supplied at least one vessel to the VN and RLN in the subaortic region. For the RLN other arterial sources were arteries arising from the aortic arch in 1 specimen, the subclavian artery in 3 specimens, the first intercostal artery in 1 specimen, and the inferior thyroid artery in all specimens. For the VN other arterial sources were arteries arising from the aortic arch in 2 specimens and the inferior thyroid artery in 1 specimen. For both the VN and RLN the veins were located under the pleura and directed towards the internal thoracic vein anteriorly and the thoracic intercostal veins posteriorly. In conclusion, the inferior thyroid artery at the thoracic inlet for the RLN and the anterior bronchoesophageal artery are the more consistent vessels supplying the VN and RLN. Vascular damage occurring during mediastinal lymph node excision to the VN and RLN, especially in the subaortic region, may explain postoperative vocal fold paralysis.

Vocal cord dysfunction after left lung resection for cancer.

OBJECTIVES: To evaluate the prevalence, the impact-related postoperative complications and the risk factors of vocal cord dysfunction (VCD) after left lung resection for cancer. METHODS: From February 1996 to April 1999, a review of prospectively gathered data was performed on 99 consecutive patients who underwent a pneumonectomy (n=50) or a lobectomy (n=49) with a mediastinal lymph node dissection. A fiber optic laryngeal examination was performed preoperatively for all patients and within the first week postoperatively in patients with symptom(s) or sign(s) of VCD or respiratory complications. RESULTS: Thirty-one patients (31%) had a postoperative VCD (group VCD) and 68 (68%) did not (group non-VCD). Mortality rate was 19% in group VCD and 9% in group non-VCD (P=0.13). Group VCD patients developed more pulmonary complications (P=0.014) and cardiac complications (P<0.001) compared to group non-VCD patients. A higher rate of reintubation (P=0.005), pneumonia (P=0.06), arrhythmia (P=0.002), cardiac failure (P<0.001) was noticeable in group VCD and may account for the higher rate of complications in this group. Using multivariate analysis, preoperative radiotherapy (P=0.001) and pneumonectomy (P=0.008) were predictive of postoperative VCD. Hospital stay was 22+/-16 days in group VCD and 13+/-9 days in group non-VCD (P<0.002). CONCLUSION: VCD is a frequent event that can lead to dramatic pulmonary complications. We would recommend to track it and to treat it as early as possible.

Influence of the mode of load carriage on the static posture of the pelvic girdle and the thoracic and lumbar spine in vivo.

The influence of various modes of carrying a load of 16 kg (15.69 DaN) on the static positioning of the pelvic girdle and the thoracic and lumbar segments of the spine was examined in seven male subjects. The displacement of cutaneous markers attached to easily palpable skeletal landmarks was recorded using 4 CCD cameras; the data acquired were analysed using an optoelectronic technique (SAGA3). The subjects stood upright on an AMTI biomechanical force platform, from which the ground reaction forces enabled displacements of the centre of gravity axis and thus the moment of the mass carried to be determined. The modes of load carriage examined were: 1) in a case in the left hand; 2) in a case in the right hand; 3) equally in two cases; 4) on the head; 5) in a rucksack; and 6) in an anterior bag. The results showed displacements of the pelvic girdle, the caudal and cranial lumbar segments, and the caudal and cranial thoracic segments in the three orthogonal planes (sagittal, frontal and transverse). The influence of the moment created by the load was seen in the statokinesigrams. The use of external markers using an optoelectronic technique, in association with the ground reaction forces, enables the mode of load carriage to be determined. The results show that the influence of the moment exerted by the mode of load carriage on the gravity axis has important ergonomic consequences.

[Large ventral hernia in tropical countries: etiology and results of treatment with the Judd technique]. / La volumineuse éventration médiane en zone tropicale: étiologies et résultats du traitement par la technique de Judd.

Large ventral hernia is a most common pathology in surgical practice in tropical countries. We reported 67 cases of large ventral hernia with mean diameter about 11.7 cm. There were 41 women and 26 men. It was incisional hernia in 49 cases; recurrent ventral hernia in ten cases (after first repair six cases and after the second repair in four cases). Ventral hernia occured in 18 women after many pregnancies (mean of five pregnancies in ten years): this etiology of ventral hernia is the particularity of our practice; rarely in developed countries where number of pregnancies by women varied from two and where the women had means to abdominal wall reeducation. Another factor was excessive weigh: in our country, woman must take some many kilogrammes after pregnancy by traditional practice. Without means in our hospital, preoperative exams were limited to detect and treated cardiorespiratory diseases. All patients had an repair of their ventral hernia by autoplasty like described by Judd completed by another layer with the same ligature. Postoperative time was marked by wound sepsis (11 cases), dyspnea (ten cases), intestinal pseudo-obstruction (eight cases) and three patients were died (failure of respiratory system in two cases and cardiac failure in one case). After 18 months there were seven recurrent ventral hernia, all in incisional hernia. Judd's autoplastic technic is an efficacy technic in primitive ventral hernia or for the first repair of incisional ventral hernia. Preoperative management must concern all respiratory problems and their treatment.

[Breast diseases in young women of Niger: results of a campaign for self examination awareness in a nursing school]. / Pathologie mammaire de la jeune fille au Niger: résultats d'une campagne de sensibilisation à l'autopalpation dans une école d'infirmières.

In order to favour the early diagnosis of breast cancer, the authors used an original method consisting in teaching nurses about breast tumors and cancer, and especially about self-examination of the breasts. Subsequently, 73 patients aged under 24 years were admitted to our survey: 90 per cent had an understanding of risk factors and 97 per cent were practicing self-examination. In 21 cases, consultation was carried out for mastalgia and in 12 cases for esthetic and/or banal inflammatory lesions: 40 patients presented a lump in the breast. Sonography turned out to be a better method of examination than mammography in those young women presenting breast lesions. Following surgery, histological examination found that in the majority of cases the tumour was benign (fibrocyst or adenofibromas). We were surprised by medullary carcinoma in one case.

[Colonic pseudo-obstruction disclosing bladder calculi: report of 2 cases]. / Pseudo-obstruction colique, révélatrice d'un empierrement vésical: à propos de 2 cas.

The authors report two cases of acute intestinal obstruction caused by bladder calculi and insist on differential clinical diagnosis. Simple X ray and sonography seemed to be sufficient-for diagnosis of this extrinseque colique obstruction and management consisted of removal of the bladder stones The prognosis is excellent.

[Inguinal hernia in pediatric practice]. / La hernie inguinale en pratique pédiatrique.

Inguinal hernia is a most common pathology in paediatric practice. Diagnosis is usually easy and rarely requires paraclinic exams (sonography). The main risk is strangulation, which can be complicated by testicular or ovarian atrophy. This justifies early surgical treatment. Operative mortality rate is almost nil. There is a risk of recurrence and of occurrence of contralateral hernia.

[Prognosis of strangulated inguinal hernia in the adult: influence of intestinal necrosis. Apropos of 34 cases]. / Pronostic de la hernie inguinale étranglée de l'adulte: influence de la nécrose intestinale. A propos de 34 cas.

The aim of this study was to determine the outcome for patients treated for strangulated inguinal hernia with intestinal resection for gangrenous. Between May 1997 and November 1998, 124 patients were admitted to our hospital for acute intestinal obstruction; 34 of them were treated for strangulated inguinal hernia and 17 underwent an intestinal resection. The outcome for the 34 patients with strangulated hernias were analysed retrospectively. Strangulated inguinal hernia occurred in young patients (80 per cent of our patients were aged under 45 years) and strangulation had evolved over an average of 2.5 days. The clinical picture was simple strangulated hernia in 10 cases, with intestinal obstruction syndrome in 15 cases, peritonitis in 3 cases, phlegmonous hernia in 4 cases, and fistulae in one case. Fifty per cent of patients had intestinal resection with poor means of resuscitation. This resection concerned 80 per cent of patients with strangulation lasting over 72 hours. Surgical repair of hernia was performed in 24 cases at the same time. There were numerous complications, notably: wound sepsis (16 cases), post-operative peritonitis (3 cases) and multiple system failure (12 cases). The mortality rate was 40 per cent and concerned 86 per cent of patients with small bowel necrosis and 89 per cent of those admitted after 96 hours of strangulation.

[Appendicitis in Niger: current prognosis]. / Les appendicites au Niger: pronostic actuel.

Acute appendicitis remains one of the most frequent emergencies in abdominal surgery. Surgery is usually straightforward and prognosis excellent. However, outcome depends essentially on how soon diagnosis is made. In Niger, the 1990s were marked by the development of private medicine and the deterioration of services in state health structures (health centres and hospitals). The goal of this prospective study, carried out over 24 months (March 1997-March 1999) was to analyse existing appendicitis prognosis in our country. The study population was made up of 362 patients and we based our survey on a number of factors found in the medical literature, and in particular on a similar study conducted in the same hospital in 1989 by another group of surgeons. Delays in diagnosis and thus therapy still today tends to transform prognosis for simple acute appendicitis into that of peritonitis. The numerous and varied post-operative complications keep the mortality rate at 4%.

[Apropos of 2 rare severe surgical complications from the use of intramuscular and intrarectal quinine]. / A propos de deux complications chirurgicales rares graves de l'usage de la quinine intra-musculaire et intra-rectale.

Quinine by intramuscular or intrarectal injection has been found to be the best treatment for malaria in Niger, particularly in field health centres where the use of solutions can pose problems. There have been several reports of complications following injections, usually due to technical error or to the toxic side effects of quinine. In our hospital, we treated two such rare complications consisting of a case of coxal osteoarthritis induced by intramuscular injection and a case of anorectal necrotising induced by intrarectal injection. The occurrence of such life-threatening events could be reduced in frequency by teaching health personnel about techniques of quinine administration as well as its dangers.

[Spontaneous giant cephalohematoma in a 13-year-old child]. / Volumineux céphalhématome spontané chez un enfant de 13 ans.

Cephalohematoma is usually observed in the neonatal period often as a result of birthing injuries induced during difficult labor (vacuum extraction and forceps delivery). Less common causes include vascular abnormalities, aneurysm, arterial dissection, blood coagulation disturbances, and vascular wall frailty. This report describes a giant cephalhematoma with right ocular protrusion and anemia with no identifiable cause in a 13-year-old boy. Rapid recovery was achieved by surgical drainage and prompt dressing.

[Prognosis of acute intestinal intussusception in infants at the national hospital of Niamey (Niger). Eleven cases treated surgically]. / Pronostic de l'invagination intestinale aiguë du nourrisson à l'hôpital national de Niamey (Niger). A propos de 11 cas traités chirurgicalement.

In order to precise the different prognosised factors of the acute intestinal invagination of the nursling, authors hereby report results of a prospective study lead in the department of general surgery during the period of January 1989 to August 1990. Eleven nursling have been operated during that period. The study of their files showed that the standard clinical triad of the acute intestinal invagination theoretically taught in the schools of health sciences, is never definitive. The diagnostic lateness and indeed therapeutic and the lack of adequate means of pediatric resuscitation constituted the main prognosised factors of this affection. The clinical board of the patients is that of an advanced occlusion or that of a serious peritonis. The surgical operation often consisted in an intestinal resection. The immediate mortality was heavy: 55%. The authors hereby stress the necessity of a training-informing-sensitizing of the health staff in the primary sanitary facilities and the populations.

[Postpartum cardiomyopathy in the Sudanese-Sahelian area. Clinical and epidemiologic studies of 66 cases]. / La myocardiopathie post-partum en région soudano-sahélienne. Etudes clinique et épidémiologique de 66 cas.

The authors report 66 cases of peri- and postpartum cardiomyopathy. The patients' age ranged from 16 to 42 years (mean +/- SD 30 +/- 7 years). All were black women native of the western part of the Republic of Niger, Sahelian in the north, Sudanese in the south. At first examination, all had signs of congestive cardiac failure. In 67 p. 100 of the cases these signs appeared during the first six postpartum weeks. Clinical, radioscopic and echocardiographic features were always those of dilated cardiomyopathy, even when arterial pressure was high. Hypertension was present at first examination in 50.8 p. 100 of the cases, but it remained stable under treatment in 13 p. 100. These data suggest an acute postpartum hypertension. The following risk factors of the disease were identified: rural living, absence of school attendance, low family income, multiparity, identical pathology after a previous pregnancy, postpartum "quarantine" period, ritual ablutions with very hot water, large amounts of sodium in the diet, hypertension, breast-feeding and postpartum oestrogen secretion decrease. Seasonal variations were noted, with doubling of new cases during the hot and humid season. The hypothesis of a latent gravidic myocarditis is discussed: the accumulation of risk factors during the postpartum period might trigger off the clinical disease. Forty seven patients were followed up for a mean period of 15 months. Seven died, 21 (31.8 p. 100) were in complete remission and 19 in partial remission. In case of relapse, complete remission was less frequent and appeared more slowly under treatment. Persistent cardiomegaly under treatment was of poor prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)