Pratique anesthésique pour adénomectomies hypophysaires par voie endonasale à Abidjan, Côte d'Ivoire / Anesthesia for endonasal pituitary adenomectomies in Abidjan, Ivory Coast

L'objectif de l'étude est d'évaluer la pratique anesthésique au cours des adénomectomies hypophysaires par voie endo nasale à Abidjan. Méthode : Il s'agissait d'une étude rétrospective à visée analytique et descriptive, menée entre le 01 janvier 2010 et le 31 décembre 2020 et portant sur les patients admis au bloc opératoire pour une adénomectomie hypophysaire. Les caractéristiques sociodémographiques, cliniques, anesthésiques, évolutives et pronostiques ont été étudiées. Résultats : Nous avons recensé 102 patients. L'âge moyen était de 44,72±12,14 ans. Le sex ratio était de 1. Le délai de diagnostic était d'un an pour 46% (n = 47) des patients. L'hypertension artérielle était l'antécédent le plus retrouvé. Les principaux motifs de consultation étaient les céphalées et les troubles de l'acuité visuelle. Le syndrome d'hypertension intracrânien a été observé chez 67,6% (n= 69) des patients. Tous les patients ont bénéficié d'une consultation pré anesthésique. Cinquante-huit pourcent (n=59) des patients ont été classés ASA I selon la société américaine d'anesthésie. L'anesthésie générale était le seul schéma anesthésique. La durée de l'anesthésie était de plus de trois heures chez 57% (n=58) des patients et le réveil sur table a concerné 88,2% (n=90) des patients. La mortalité était de 3,9%. La durée de l'anesthésie supérieure à 6 heures (p= 0,0012 ; OR= 55,8 [4,88-637,33]) et la perte sanguine supérieure à 1000 ml (p = 0,0228 ; OR=18,6 2,152- 160,747]) ont constitué des facteurs de mauvais pronostic (p<0,05). Conclusion: La réduction de la létalité au cours de l'anesthésie pour adénomes hypophysaires passe par la lutte contre les facteurs de mauvais pronostics

Invagination colo-colique sur lipome du cæcum chez l'adulte / Colocolic invagination on lipoma of the cecum in adults

L'invagination intestinale aiguë colocolique chez l'adulte est rare dans l'ordre de 5% des occlusions intestinales de l'adulte selon la littérature. Les causes sont organiques et l'invagination sur un lipome est exceptionnel. Nous rapportons un cas d'invagination colo-colique sur un lipome sous-muqueux du cæcum dans une forme pseudo tumorale chez une femme de 51 ans de découverte opératoire. La clinique était celle d'une occlusion intestinale sur une masse abdominale. Au plan thérapeutique, une hémicolectomie droite emportant la masse tumorale avec anastomose manuelle iléo-colique terminolatérale a été effectuée. L'histologique de la pièce opératoire était un lipome sous muqueux du cæcum. Les suites opératoires étaient simples. L'invagination colo-colique par lipome est rare. Le diagnostic étiologique est histologique et le traitement chirurgical

Acute colonic intussusception in adults is rare, accounting for around 5% of intestinal obstructions in adults according to the literature. The causes are organic and intussusception on a lipoma is exceptional. We report a case of colonic intussusception on a submucosal lipoma of the cecum in a pseudo-tumorous form in a 51-year-old woman discovered at surgery. The clinic was that of an intestinal obstruction on an abdominal mass. Therapeutically, a right hemicolectomy removing the tumor mass with manual endto-side ileocolic anastomosis was performed. The histology of the surgical specimen was a submucosal lipoma of the cecum. The postoperative course was simple. Colocolic intussusception due to lipoma is rare. The etiological diagnosis is histological and the treatment is surgical.

[Detection of the IS2404 insertion sequence and ketoreductase produced by Mycobacterium ulcerans in the aquatic Heteroptera in the health districts of Dabou and Tiassalé in Côte d'Ivoire]. / Mise en évidence de la séquence d'insertion IS2404 et de la kétoréductase (Kr) produite par Mycobacterium ulcerans chez les Hétéroptères aquatiques dans les districts sanitaires de Dabou et Tiassalé en Côte d'Ivoire.

Buruli ulcer (BU) disease, caused by Mycobacterium ulcerans, is a major public health problem in Côte d'Ivoire. Until now, the mode of BU transmission was unknown, but recent studies implicate aquatic Heteroptera in the chain of transmission. This study was launched in Côte d'Ivoire to search for specific genetic markers for M. ulcerans in these bugs, including the insertion sequence IS2404 and ketoreductase (Kr), both involved in the synthesis of mycolactone, a toxin produced by these mycobacteria. Samples of aquatic Heteroptera were collected monthly with deep nets from ponds near villages in the health districts of Dabou and Tiassalé. After identification and enumeration of the bugs, batches of the same taxon underwent real-time PCR to search for the IS2404 target and Kr. Saliva of 69 specimens of Diplonychus sp randomly selected in the samples was also analyzed by PCR. In all, 283 single-taxon batches were created. Thus, PCR identified 26 batches belonging to the families of Belostomatidae, Naucoridae, Corixidae, Ranatridae, and Nepidae as positive for both targets. The IS2404 insertion sequence and Kr were present in 6 of the 69 samples analyzed in the saliva of Diplonychus sp. These aquatic Heteroptera suspected of infection by M. ulcerans might release it into the environment because of their ability to fly. They might thus be the source of human contamination.

[Psychiatric morbidity in prison population: prevalence survey In the home judgment and correcting of Abidjan (Côte d'Ivoire)]. / Morbidite psychiatrique dans une population carcerale : enquete de prevalence a la maison d'arret et de correction d'Abidjan (Cote d'Ivoire).

OBJECTIVE: To determine the prevalence of psychiatric disorders in a prison population in Abidjan (Côte d'Ivoire). PATIENTS AND METHODS: This was a descriptive cross-sectional study, conducted from June to August 2008 at the Medical Department of the Prison and Correctional Center of Abidjan (PCC). 200 inmates were interviewed following the completion of a MINI supplementing a questionnaire on sociodemographic and penitentiary data. RESULTS: The prison population of this study was predominantly male (90%) with a mean age of 33 years. Nearly half of the prisoner were single and without children (52.5%) and serving their first incarceration (54%); 76.5% of the inmates had completed at least 12 months in detention. The study found that 76% of prisoners had a DSM IV Axis I psychiatric disorder. The prevalence of major depressive episodes was 50.5% with an estimated 38.5% suicide risk. 23% had antisocial personality and 11% of respondents displayed a psychotic syndrome. Illicit drugs were found in 14% of prisoners and abuse of these drugs was reported by 17% of them. 8% had a state of post-traumatic stress and 3.5% obsessive compulsive disorder. CONCLUSION: The high prevalence of psychiatric morbidity in the prison settings argues in favor of a better organization of medical and psychological assistance to inmates.

OBJECTIF: Déterminer la prévalence des troubles psychiatriques dans une population carcérale à Abidjan (Côte d'Ivoire). PATIENTS ET MÉTHODE: Il s'agissait d'une étude descriptive réalisée de Juin à Août 2008 au Service Médical de la Maison d'Arrêt et de Correction d'Abidjan (MACA). 200 détenus ont été interviewés à partir duMINI complété d'un questionnaire relatif aux données sociodémographiques et carcérales. RÉSULTATS: La population carcérale de notre étude était majoritairement masculine (90%) avec une moyenne d'âge de 33 ans. Un détenu sur deux était célibataire sans enfant (52,5%) et primo-incarcéré (54%) ; 76,5% des détenus avaient au moins 12 mois de détention. L'étude a révélé que 76% des détenus présentaient un trouble psychiatrique de l'axe I du DSM IV. La prévalence d'épisode dépressif majeur était de 50,5% avec un risque suicidaire estimé à 38,5%. 23% présentaient une personnalité antisociale et 11% des interviewés présentait un syndrome psychotique. La dépendance aux drogues illicites existait chez 14% des détenus et l'abus de ces drogues était déclaré par 17% d'entre eux. 8% souffraient d'un état de stress post-traumatique et 3,5% d'un trouble obsessionnel compulsif. CONCLUSION: La prévalence élevée de la morbidité psychiatrique en milieu carcéral milite en faveur d'une meilleure organisation de l'assistance médico-psychologique des détenus.

[One step surgery for severe African endocrine exophtalmia: clinical case]. / Chirurgie en un temps d'une exophtalmie basedowienne africaine sévère: présentation d'un cas clinique.

INTRODUCTION: The association hyperthyroidism-exophtalmia is pathognomonic of the Graves disease. Classically, the treatment is based on a pluridisciplinary step-by-step approach with a precise chronology. In some African places, these optimal conditions are not present. When confronted to such particular situations, it can be proposed to treat surgically at the same time the endocrine disease and the ophthalmologic complications. OBSERVATION: The authors report the case of a 42-year-old women suffering of a great thyreotoxic goiter with severe bilateral exophtalmia, treated by thyroidectomy and orbital decompression in the same session with a good result after 18 months. DISCUSSION: This non-conventional approach can be useful in particular situations when the medical environment is not optimal. It permits the radical treatment of their disease and improves the prognosis of patients with poor capacities for survey.

Surface modifications of illite in concentrated lime solutions investigated by pyridine adsorption.

The surface properties and functionality of an illite-containing clay mineral in alkaline solutions containing increasing quantities of calcium hydroxide were investigated using FTIR monitored pyridine adsorption at various temperatures. Results showed that the binding behavior of electron donor pyridine molecules to illite platelets is mostly governed by electron acceptor sites located at the edges of the clay particles. The binding of bulky hydrated calcium ions at the surface of the illite platelets decreases the surface area of illite. Moderate thermal treatments up to 450°C do not affect the structure of the clay mineral but strongly decrease the number of Lewis and Brönsted sites available at the edges of the clay platelets.

Grossesse et risques d'irradiations en radiodiagnostic : etat des connaissances des usagers au CHU de Yopougon

Objectifs : Evaluer l'etat des connaissances des usagers et des professionnels de la sante sur les risques d'irradiation de la femme enceinte au cours des explorations radiologiques et l'observation de l'application des regles de radioprotection relative a la femme enceinte par les utilisateurs de rayons X. Materiel et methodes : Notre etude prospective; realisee au CHU de Yopougon; a dure 6 mois. Nous avions interroge 60 femmes en grossesse ou susceptibles de l'etre; 30 medecins prescripteurs non radiologues; 29 techniciens d'imagerie medicale et 21 aides soignants sur les risques d'irradiation et les mesures de protection de la femme enceinte avant et pendant la realisation d'un examen radiologique utilisant les rayons X. Resultats : 73;68des medecins prescripteurs n'avaient pas de culture en radioprotection chez une femme enceinte ou en age de procreer. 93;10des patientes enceintes ou en age de procreer ignoraient l'existence des rayons X en radiodiagnostic et leur nocivite pour une femme enceinte ou susceptible d'etre enceinte. 80des manipulateurs de radiologie respectaient pas les regles elementaires de radioprotection. Conclusion : La sensibilisation des usagers des rayons X sur les risques d'irradiations chez une femme enceinte ou susceptible de l'etre est necessaire au CHU de Yopougon

[Resistance of Anopheles gambiae s.l. to pyrethroids and DDT at Tiassalékro, an irrigated rice-growing village in the southern forest of Ivory Coast]. / Résistance d'Anopheles gambiae s.l. aux pyréthrinoïdes et au DDT à Tiassalékro, village de riziculture irriguée en zone sud forestière de Côte-d'Ivoire.

An assessment of the sensitivity of Anopheles gambiae s.l.to three pyrethroids (alphacypermethrin, permethrin, deltamethrin) and DDT has been carried out with a laboratory strain (Kisumu reference sensitive strain) and a wild strain (Tiassalékro strain) using larvae from an irrigated rice-growing area of Tiassalékro, located in the southern forest of Ivory Coast. The sensitivity tests were performed according to the standard WHO cylinder tests with adult female A. gambiae s.l. aged 2 to 4 days. The results showed that the strain of Tiassalékro is resistant to the three tested pyrethroids and DDT. The molecular forms M and S were identified, with a predominance of M form. The resistance mechanism involved is the Kdr mutation. In this region, control measures against malaria vectors by using bed nets impregnated with these insecticides or household sprays could be compromised.

[Micronecta sp (Corixidae) and Diplonychus sp (Belostomatidae), two aquatic Hemiptera hosts and/or potential vectors of Mycobacterium ulcerans (pathogenic agent of Buruli ulcer) in Cote d'Ivoire]. / Micronecta sp (Corixidae) et Diplonychus sp (Belostomatidae), deux hémiptères aquatiques hôtes et/ou vecteurs potentiels de Mycobacterium ulcerans agent pathogène de l'ulcère de Buruli en Côte d'Lvoire.

Buruli ulcer is currently a major public health problem in Côte d'Ivoire. It is a neglected tropical disease closely associated with aquatic environments. Aquatic insects of the Hemiptera order have been implicated in human transmission of Mycobacterium ulcerans, the pathogenic agent of Buruli ulcer. The purpose of this preliminary study using the polymerase chain reaction (PCR) method was to evaluate aquatic insects in Sokrogbo, a village in the Tiassalé sanitary district where Buruli ulcer is endemic. Findings identified two water bugs hosting Mycobacterium ulcerans, i.e., one of the Micronecta genus in the Corixidae family and another of the Diplonychus genus in the Belostomatidae family. The PCR technique used revealed the molecular signatures of M. ulcerans in tissue from these two insects. Based on these findings, these two water bugs can be considered as potential hosts and/or vectors of M. ulcerans in the study zone. Unlike Diplonychus sp., this is the first report to describe Micronecta sp as a host of M. ulcerans. Further investigation will be needed to assess the role of these two water bugs in human transmission of M. ulcerans in Côte d'Ivoire.

[Occupational related burns in Abidjan]. / Brulures En Milieu Proffessionnel A Abidjan.

Occupation-related burns are important issue for public health area because of its socioeconomic impact for enterprises, victims and society. We performed this study in order to define the epidemiological characteristics of these accidents. We used a retrospective study that concerned occupation-related burns notified as work accident at the national insurance fund (CNPS) for private sector in Côte d'Ivoire. 363 files were selected. Men workers (95.6 %) and the age category from 20 to 39 (71 %) were more concerned. Most of victims were skilled workers (40.4 %) and unskilled workers (36.6 %). Burns occurred mainly in industrial sector than in others (70.8 %). Heat sources were involved in 238 cases of burns (65.6 %). Injuries were mostly superficial. Total temporary disability duration less than or equal to 28 days concerned 252 workers (70.4 %) and after effects with permanent partial disability concerned 64 workers. Most of victims return at the same workstation without modification (98.9 %). Prevention measures should be implemented in high burn risk factories through a program focused on fire safety, electric safety and chemical safety.

[Immunological aspects of a case of extragenital endometriosis localized in the mouth]. / Aspects immunologiques d'un cas d'endométriose extra-génitale à localisation buccale à Abidjan.

To appreciate the role of the immune system in transportation and development of endometer cells in mouth, authors reported the results of immunological parameters analysis in one patient suffering to a mouth localisation healed endometriosis out of hormonal therapy in experimental and analytic study. Immunoglobulin A, G, M and C3, C4 complement fractions were measured by Mancini radial immunodiffusion. The count of CD4+, CD8+and B Cell was performed by BD FASCalibur flow cytometer. Autoimmune diseases were searched after by measuring autoantibodies using agglutination and immunofluoresence methods. The results showed any antibodies detected and the count of CD4, CD8 and B cells was normal. However, IgG and IgA increased. But C3, C4 factions and IgM decreased. This seems an immunological disorder which could be more explored in NK cells and cytokines study.

[Specific diversity and culicidian nuisance in the villages of N'gatty and Allaba in laguna area of Ivory Coast]. / Diversité spécifique et nuisance culicidienne dans les villages de N'gatty et d'Allaba en milieu côtier lagunaire de Côte-d'Ivoire.

Entomological surveys were undertaken between June and December 2006 in N'gatty and Allaba. These villages are located in southern Ivory Coast in a laguna area in Dabou department. In these villages, there are large swampy areas, which have caused the multiplication of anthropophilic Culicidae. Mosquitoes have been collected at preimaginal stage at the time of the larval prospecting and at adult stage through human landing catch. Larval collections have been made using the classic method of "dipping". Larvae have been identified to the genus level. Then, they have been bred in the laboratory to identify adults. Adults collection has been made once a month during three consecutive nights by human landing catch inside houses. Adults have been identified to the specific level. Eight genera of mosquitoes have been collected in these two villages: Aedes, Anopheles, Coquillettidia, Culex, Eretmapodites, Mansonia, Toxorhynchites and Uranotaenia. Twenty-four species have been listed during this stu y. The genus Mansonia is the most predominant with 86% (N = 15,811) and 80% (N = 1,385), respectively, in N'gatty and Allaba. The average biting rate per day varies between N'gatty and Allaba. It is estimated to 308 bites per human per night (b/h/n) in N'gatty and 72 b/h/n in Allaba. In these villages, mosquito nuisance is mainly due to Mansonia with 264 b/h/n and 58 b/h/n, respectively, in N'gatty and Allaba. However, Anopheles gambiae s.l. average rate was 12 b/h/n in N'gatty and 2 b/h/n in Allaba.

In vitro conservation of oil palm somatic embryos for 20 years on a hormone-free culture medium: characteristics of the embryogenic cultures, derived plantlets and adult palms.

This study was conducted over a period of 20 years, to assess the problems involved in developing subcultures over a very long period, of oil palm (Elaeis guineensis Jacq.) somatic embryos which were maintained in vitro on a Murashige and Skoog mineral-based culture medium, without growth regulators. Analysis of the proliferation rate of the embryogenic cultures, along with the survivability of the regenerated plantlets after their transfer into soil and of the flowering of the derived adult palms has been conducted for cultures maintained in vitro during 1 to 20 years. From the ninth year of maintenance, the tissue quality of the somatic embryos gradually began to decline. However, after more than 20 years, 30% of the 20 clones tested still continued to proliferate satisfactorily on the same maintenance medium, keeping their multiplication potential intact. Even though a depressive effect of the age of the lines has been observed on the survival capacity of plants under natural conditions, it is noteworthy that among the clones originating from 20-year-old cultures only eight of them (40%) have exhibited the "mantled" floral abnormality. Different hypotheses concerning the origin of the disruptions observed on the in vitro cultures, plantlets and adult palms that occur over a very long period of in vitro conservation are discussed.

[Diagnostic and therapeutic aspects of parotid tumors in the Maxillofacial Surgery Department of the University Hospital Center in Treichville, Abidjan]. / Les aspects diagnostiques et thérapeutiques des tumeurs parotidiennes en chirurgie maxillo-faciale au CHU de Treichville Abidjan.

INTRODUCTION: Taking charge of parotid tumors in an African setting is difficult because of the weakness of the technical, delayed consultation, treatment of traditional healers, tumor volume, secondary infection and ulceration of some of them. OBJECTIVE: Identify the epidemiological, clinical, evolutive and therapeutic in order to propose an adapted scheme to the management of these tumors in our African conditions. MATERIALS AND METHODS: This is a retrospective study of 38 patients with parotid tumors operated and hospitalized in the department of stomatology and maxillofacial surgery university hospital of Treichville (Abidjan), during the period from January 2005 to December 2009 included, so a period of 5 years. RESULTS: The study involved 21 (55.3%) men for 17 (44.7%) women aged between 8 and 75 years came to 76.31% for parotid tumor. In 55.26% patients consulted between 1 and 5 years. Clinically: general condition was preserved in 91.1%, tumor size ranged between 5 and 10 cm in 60.53%, they were in the form of nodules in 78.9%, were covered with healthy skin in 78.95%, appeared as isolated tumor in 72.06%. Ultrasound examination was the most paraclinical exam used (65.79%). The tumors were benign in 76.3% dominated by pleomorphic adenoma (63.2%). The most common malignant tumor was muco epidermoid carcinoma (7.9%). Exo-facial parotidectomy was the most common technique used (60.52%). The rate of patient follow-up at 2 years was 5.26%. CONCLUSION: Social and cultural conditions of the management of tumors and lack of technical platform lead us to propose the total parotidectomy for a better cure rate of patients.

[Diagnostic and surgical approach to an hourglass-shaped nasopalatine glioma in an infant]. / Approche diagnostique et chirurgicale d'un gliome naso-palatin "en sablier" chez un nourrisson.

The authors report a case of glioma nasopalatine Multifoil in wallet, location-intra nasal and palatal left. The nasal glioma is a rare congenital malformation presenting as a nasal mass composed of neuroglial tissue heteropias resulting from an abnormality in embryonic development. It is a benign tumor that fits into the nosology of the masses of the midline. This abnormality arises primarily a diagnostic problem because often mistaken for a meningo-encephalocele or a nasal dermoid cyst. Localization nose and palate, an hourglass, is extremely rare if not exceptional; The computed tomography (CT) has enabled the accurate assessment of injury and has guided the choice of surgical technique. The resection was done successfully without recurrence. Histology examination of the surgical specimen confirmed the nature of astrocytic neuroglial tumor. The location of the tumor pedide palate to that of the left nostril is special and especially histological diagnosis of this congenital malformation.

Comparison of surface properties between kaolin and metakaolin in concentrated lime solutions.

The surface adsorption of calcium hydroxide onto kaolin and metakaolin was investigated by monitoring with atomic emission spectroscopy and pH measurements the amounts of ions left in solution after exposing clays to calcium hydroxide solutions of various concentrations. Both clays adsorb calcium and hydroxyl ions but differently. Kaolin adsorbs calcium hydroxide not only at the edges of the clay particles but also onto the basal faces. The adsorbed hydrated calcium ions form a layer on the clay particle surfaces, preventing further dissolution of the clay mineral platelet. Metakaolin shows high pozzolanic activity, which provides the quick formation of hydrated phases at the interfaces between metakaolin and lime solutions. The nature of the hydration products has been investigated using X-ray diffraction (XRD) and differential thermal analysis (DTA). The most important hydrated phases like CSH (hydrated calcium silicate) and C(2)ASH(8) (gehlenite) have been identified.

Prise en charge des fractures associées des membres et de la face. Notre experience au CHU de Treicheville (Abidjan)

Trente six (36) dossiers de patients présentant unefracture concomitante des membres et de la face ontété revus de façon rétrospective. Il s'agissait de 26hommes et 10 femmes âgés en moyenne de 32,91 ans(extrêmes 03 à 70 ans) tous admis au CHU de Treichvilleentre janvier 1998 et octobre 2003.Les accidents dela voie publique représentaient l'étiologie la plusfréquente (77,8%). Le membre inférieur était intéressédans 69,44% des cas et les lésions maxillo-faciales selocalisaient à l'étage inférieur dans 61,11%. Lesassociations lésionnelles fréquentes étaient lesfractures mandibulaires associées aux fractures dufémur (13,88%). Les sièges des fractures étaient divers etaucune association n'était significativement pré-pondérante pour expliquer des circonstancesétiopathogéniques particulières.Les moyens thérapeutiques utilisés dans les deuxspécialités ont été dominés par les traitementsorthopédiques. En définitive, 36,11% des patients ontété pris en charge dans le même temps opératoire,séparément et de façon différée pour 63,89% destraumatisés.L'évolution a été simple chez 29 patients, soit80,6% avec une consolidation acquise pour toutesles lésions fracturaires. Des complications ont étéobservées et se résumaient en 5 sepsis superficielset une nécrose commissurale. Une séquelle a typede raideur du poignet a été constaté.Au sein d'une même structure hospitalière la priseen charge des fractures maxillo faciales et desmembres doit obéir à une concertation préalable entreles spécialités afin de permettre un traitement rapideet complet des lésions

[Preoperative diet and complete dentures in Ivory Coast]. / Diététique préopératoire et prothèse adjointe totale en Côte d'Ivoire.

The toothless patients of developing country are a real problem of nutrition. The practitioners are in the habit of doing the prostheses restoration wit hoof thinking of alimentation. In this work, authors show the energetic and protein malnutrition of the toothless patients of Cote d'lvoire and propose a hyperprotein diet with their alimentation habit in order to prepare the psychic and physic site who must receive complete prostheses.