[Septo-optic dysplasia (De Morsier's syndrome). About one case discovered during the pregnancy]. / Découverte anténatale d'une dysplasie septo-optique (syndrome de De Morsier).

The authors report a case of septo-optic dysplasia discovered during the pregnancy without another abnormality. It's a rare cerebral abnormality that is characterized by an absence of septum pellucidum associated to a hypoplasia of ways and optic chiasm to variable degrees. Discovery is often made for adulthood. Future is extremely wide. It is determined with the arisen to different degrees of incapacity of Pituitary gland, psychomotor delay of variable intensity with mental deficiency, a visual confusion, and a confusion of the regulation of the temperature.

[Value of hand disinfection by rubbing with alcohol prior to surgery in a tropical setting]. / Intérêt de la désinfection chirurgicale des mains par friction alcoolique en milieu tropical.

OBJECTIVE: The purpose of this study was to assess the value of hand disinfection by rubbing with alcohol in terms of prevention of surgical site infection (SSI) and cost in a tropical setting. MATERIAL AND METHOD: This prospective cohort study carried out in the Gynecology Obstetrics Department of the Yopougon University Teaching Hospital from May to September 2005 was designed to compare two different methods of hand disinfection, i.e., traditional 3-step hand scrubbing using an antiseptic preparation versus handwashing without an antiseptic preparation followed by two applications of an aqueous alcohol solution. RESULTS: The study population included 318 patients who underwent surgery during the study period. The SSI rate was 13.2% in patients operated on after traditional hand scrubbing and 11.5% after handwashing followed by rubbing with alcohol (not significantly different). Hand disinfection by rubbing with alcohol did not increase the risk of SSI and was considered as easier than traditional hand scrubbing by 90% of users. Skin tolerance was deemed good by 52% of users. Most users (69%) wished both hand disinfection methods to be available. Hand disinfection by rubbing with alcohol was much more cost-effective than traditional hand scrubbing both with regard to initial investment and to consumable costs (50% lower). CONCLUSION: This study shows that hand disinfection by rubbing with an alcoholic solution is not only as effective as traditional hand scrubbing for prevention of SSI but also more cost-effective. These findings indicate that rubbing with alcohol is a suitable alternative to traditional scrubbing for hand disinfection prior to surgery in our tropical setting.

[Internal iliac arteries ligation for intractable obstetrical hemorrhage in Africa]. / Ligature des artères iliaques internes face aux hémorragies obstétricales graves en milieu africain.

OBJECTIVES: Assess the efficiency of internal iliac arteries ligation in intractable obstetrical hemorrhage and ascertain success or failure factors. PATIENTS AND METHODS: It was a retrospective study which concerned 159 patients who underwent internal iliac arteries ligation for persistent and severe obstetrical hemorrhage from March 1992 to February 2007. Arrest of hemorrhage after ligation with survival of the patient was considered as successful; was considered as failure, persistence of hemorrhage in spite of the ligation or patient death. RESULTS: Internal iliac arteries ligation allowed hemorrhage control in 84.3% of cases. Main etiology of hemorrhage were: uterine atony (42.8%), abruptio placentae (31.4%). Coagulation disorders and hypovolemic shock, consequences of long delay of management were identified as bad prognosis factors. Blood transfusion was also singled out as a factor likely to ameliorate prognosis, especially in hemodynamic precarious situations. Surgical complications incidence was 1.89%, represented by two internal iliac vein lesions and one ureteral section successfully repaired. DISCUSSION AND CONCLUSION: Internal iliac arteries ligation is a prerequisite treatment of severe postpartum hemorrhage. The outcome is better when it is performed precociously (p=0.0000003) before the happening of disseminated intra vascular coagulation (p=0.006), hemodynamic troubles (p=0.0099) and acute severe anemia (p=0.02). It is a good alternative to arterial embolization in Africa.

Intérêt de la désinfection chirurgicale des mains par friction alcoolique en milieu tropical

Objectif. Determiner l'efficacite de la desinfection chirurgicale des mains par friction alcoolique en terme de survenue d'infection du site operatoire et en apprecier l'interet economique en milieu tropical. Materiel et methode. Il s'agissait d'une etude prospective de cohorte qui s'est deroulee de mai a septembre 2005 dans le service de gynecologie obstetrique du CHU deYopougon; comparant deux protocoles de desinfection des mains : le lavage chirurgical classique en 3 temps et la friction chirurgicale qui comprenait un lavage simple des mains suivi de deux applications successives d'une solution hydro alcoolique. Resultats. L'etude a porte sur 318 patientes. Les taux d'infection du site operatoire etaient de 13;2pour le groupe lavage et de 11;5pour le groupe friction (sans difference significative). La friction chirurgicale n'a pas expose a plus de risque d'infection et a ete jugee plus facile que le lavage chirurgical classique par 90des utilisateurs. La tolerance cutanee a ete jugee bonne dans 52des cas. Enfin; 69des utilisateurs souhaitaient que les deux protocoles soient maintenus. L'interet economique de la friction etait majeur par rapport au lavage tant en terme d'investissement que sur le prix des consommables; moins cher de 50. Conclusion. La friction chirurgicale s'est montree aussi efficace que le lavage chirurgical dans la prevention des infections du site operatoire tout en etant plus economique. Cette technique est une bonne alternative au lavage chirurgical des mains en milieu tropical

[Congenital lobar emphysema: a rare etiology of hyperechoic lung]. / Une étiologie rare de poumon hyperéchogène: l'emphysème lobaire géant congénital.

Lobar congenital emphysema is a rare pulmonary malformation corresponding to progressive overinflation of a pulmonary lobe secondary to partial bronchial obstruction. Prenatal diagnosis is mainly based on lung hyperechoic area. Sonographic features are not specific highlighting the interest of fetal MRI or postnatal tomodensitometry. This case report describes prenatal detection including pitfalls and postnatal management.

[Management of rhesus alloimmunisation by spectrophometry: about one case at the Yopougon Teaching Hospital, Côte-d'Ivoire]. / Prise en charge de l'alloimmunisation rhesus par la spectrophotometrie : a propos d'un cas au CHU de Yopougon, Côte-d'Ivoire.

The authors report a care management of a patient presenting a severe alloimmunisation treated by spectrophotometry, a very efficient method but difficult of access in developing countries. Beyond the restrictive paraclinical exams which do not allow an efficient monitoring of this pathology, the lack of alloimmunisation prevention during illegal abortions and the lack of information about patients'medical files are highly responsible for the difficult management of Rhesus- negative patients. However the authors remind that only the scan at best combined with the Doppler, are effective exams helping to avoid the constraints of spectrophotometry. Although quite well-known this pathology induces very severe foetal consequences and may involve the obstetric prognosis of young women. The caesarian section will still remain for a long time the only means to prevent foetus from alloimmunisation complications in developing countries.