Profil lipoprotéique et risque athérogène chez les drépanocytaires majeurs au CHU de Cocody / Lipid Profile and Atherogenic Risk of Major Sickle Cell Disease Patients in Abidjan

Introduction.Les formes majeures dedrépanocytose sont une source de perturbation des paramètres lipidiques. Cette perturbation est impliquée dans l'apparition de nombreuses maladies cardiovasculaires telles que les accidents vasculaires cérébraux. Cette étude avait pour but d'établir la relation entre les formes majeures de la drépanocytaire, le risque athérogène et l'état inflammatoire des sujets. Méthodologie. Il s'agit d'une étude transversale à visé analytique qui s'est déroulée dans les services d'hématologie du CHU de Cocody et dans le laboratoire de biochimie de l'UFR des Sciences Médicales d'Abidjan portant sur les sujets drépanocytaires majeurs et de sujets apparemment sains admis au CHU de Cocody pendant la période de l'étude. Résultats.Nous avons recrutéun total de 57 sujets drépanocytaires (SS, SC, Sß0,Sß+) et 44 sujets apparemment sains sur la base d'une électrophorèse de l'hémoglobine.L'âge moyen des sujets drépanocytaires était de 17,77 ans avec des extrêmes de 2 et 67 ans. On notait une prédominance féminine avec un sex-ratio de 1,48.Les cholestérolémies totales moyennes des drépanocytaires SS et SC étaient plus faibles comparativement à celles des drépanocytaires Sß0, Sß+et de la population témoin avec une différence statistiquement significative (p= 0,0031).Les triglycéridémies moyennes des drépanocytaires (SS et SC) étaient plus basses en comparaison à celles des témoins et des drépanocytaires Sß0et Sß+. Les valeurs moyennes de l'indice d'athérogénicité des sujets drépanocytaires étaient élevées que chez les témoins avec une différence statistiquement significative(p = 0,001). les drépanocytaires avaient des concentrations de CRP significativement plus élevée avec p = 0, 0015.Conclusion.Chez les sujets drépanocytaires, les valeurs augmentées de l'indice d'athérogénicité, des triglycérides, de la CRP et la baisse de la concentration du cholestérol HDL expliqueraient un risque athérogène plus élevé. Il est importantd'introduire le bilan lipidique dans le suivi du patient drépanocytaire

Introduction.The major forms of sickle cell disease are a source of disruption to lipid parameters. This disruption is implicated in the development of many cardiovascular diseases such as strokes. The aim of this study was to establish the relationship between the major forms of sickle cell disease, atherogenic risk, and the inflammatory state of subjects. Methodology.This was a cross-sectional analytical study conducted in the hematology departments of the Cocody University Hospital and the biochemistry laboratory of the Faculty of Medical Sciences in Abidjan, focusing on major sickle cell subjects and apparently healthy subjects admitted to the Cocody University Hospital during the study period. Results.A total of 57 sickle cell subjects (SS, SC, Sß0, Sß+) and 44 apparently healthy subjects were recruited based on hemoglobin electrophoresis. The average age of sickle cell subjects was 17.77 years with a range of 2 to 67 years. There was a female predominance with a sex ratio of 1.48. The mean total cholesterol levels of SS and SC sickle cell subjects were lower compared to those of Sß0, Sß+ sickle cell subjects and the control population with a statistically significant difference (p=0.0031). The mean triglyceride levels of sickle cell subjects (SS and SC) were lower compared to controls and Sß0 and Sß+ sickle cell subjects. The mean atherogenicity index valuesof sickle cell subjects were higher than in controls with a statistically significant difference (p=0.001). Sickle cell subjects had significantly higher CRP concentrations with p=0.0015. Conclusion.In sickle cell subjects, increased values of the atherogenicity index, triglycerides, CRP, and decreased HDL cholesterol levels would explain a higher atherogenic risk. It is important to include lipid profile assessment in the treatmentent of sickle cell disease

Operative versus conservative treatment for giant omphalocele: Study of French and Ivorian management.

INTRODUCTION: The giant omphalocele is currently a surgical challenge. The morbidity and mortality associated with its care is non-negligible. Nowadays, different studies have revived the debate between conservative and surgical management for giant omphalocele. The purpose of this study is to compare the conservative and surgical management of the giant omphalocele in terms of morbidity and mortality. METHODS: Retrospective study including all giant omphaloceles comparing surgical management (French University hospital centers) and tanning (Ivory Coast University hospital center). Epidemiology was studied as well as medical and surgical managements both intra and post operative. RESULTS: One hundred and forty-seven patients included (98 patients in the "tanning" group and 49 in the "surgery" group). Hospital length of stay is significantly shorter in the "tanning" group as they do not spend time in intensive care unit. Morbidity is higher in "surgery" group. The average duration for oral empowerment was acquired at 179 days in the "surgery" group, whereas in the "tanning" group 90% was immediately and exclusively breastfed. No significant differences in terms of epithelialization time. CONCLUSION: The tanning treatment has its own place in the therapeutic arsenal in the management of the giant omphalocele no matter where it takes place. However, its realization in surgical environments prevents certain complications related to the technique or the pathology.

[Prevalence and characteristics of metabolic syndrome among hypertensive patients in Abidjan]. / Prévalence et caractéristiques du syndrome métabolique chez les hypertendus à Abidjan.

AIM: Assess prevalence of metabolic syndrome (MetS) in black Africans hypertensive patients. POPULATION: Prospective survey from 3rd November 2014 to 12th June 2015, at Abidjan Heart Institute. Study was carried out among patients aged 18 years old, admitted to external consultation. Oral consent was obtained. MetS was established based on the definitions of the NCEP-ATP III 2005 and the International Diabetes Federation (IDF). RESULTS: Over 1246 hypertensive patients, 404 were included in our study. The prevalence of MetS was 48.8% according to the criteria of the NCEP-ATP III 2005 and 51% according to the IDF. We noticed a female predominance (69% against 31%, P<0.001). Central obesity (49.5%) and low HDL-cholesterol (42.1%) were the factors defining the SM most predominant in our series. Low blood pressure control was higher in the presence of MetS (43.6%). The average number of antihypertensive prescribed drugs were significantly higher (2.2±0.8 against 2±0.8, P<0.001). MetS was significantly associated with obesity (BMI≥30kg/m(2) : 40.6% against 14%, P<0.001). Cardiovascular complications were observed in 54.8% of hypertensive patients in the presence of MetS. CONCLUSION: MetS is a reality in sub-Saharan Africa. Adequate preventive measures are needed to limit its progression.

Living Kidney Donor Transplantation in a Resource-limited Country: The Ivory Coast Experience.

Renal transplantation that offers a good quality of life still is not performed by the majority of countries of black Africa. We started a pilot project of renal transplantation in Ivory Coast 2 years ago. The present paper reports the preliminary results, difficulties related to the program, and perspectives regarding its expansion. Ten living related kidney transplantations have been performed over a 2-year period. Recipients and their respective donors were male. The mean age of the recipients was 42.8 years (22-57), and the mean age of the donors was 29.4 years (22-43). The mean number of mismatches was 3.2 (0-6). None was immunized. Recipients and donors were all EBV IgG positive and CMV IgG positive. All but 1 case were induced with basiliximab. The mean graft and patient survival time was 16.6 months (6-26). The mean cold ischemic time was 2.27 hours (1-3.32). The mean serum creatinine at discharge was 241.87 µmol/L (115.18-1063.2), at 6 months was 117.20 µmol/l (95.6-139.9), at 12 months was 104.55 µmol/L (62.02-132.9), and at 24 months was 104.55 µmol/L (62.02-132.9). The mean cyclosporine through level (C0) at 6 months was 137.57 ng/mL (70-366), at 12 months was 117.33 ng/mL (62-197), and at 24 months was 78 ng/mL. The mean cyclosporine 2-hour post-administration concentration levels (C2) at 6 months was 764.9 ng/mL (430-1421), at 12 months was 937.17 ng/mL (483-1292), and at 24 months was 690.66 ng/mL (488-853). Main complications were sepsis, adenovirus hemorrhagic cystitis, new-onset diabetes after transplantation, delayed graft function, polycythemia, and cytomegalovirus infection. No clinical rejection was diagnosed over the 2-year period. Patient and graft survival was 100% at a mean post-transplantation time of approximately 16.6 months.

Outcomes of conservative treatment of giant omphaloceles with dissodic 2% aqueous eosin: 15 years' experience.

BACKGROUND: The surgical management of giant omphalocele is a surgical challenge with high mortality and morbidity in our country due to the absence of neonatal resuscitation. This study evaluates conservative management of giant omphalocele with dissodic 2% aqueous eosin. MATERIALS AND METHODS: In the period from January 1997 to December 2012, giant omphaloceles were treated with dissodic 2% aqueous eosin. The procedure consisted of twice a day application of dissodic 2% aqueous eosin (sterile solution for topical application) on the omphalocele sac. The procedure was taught to the mother to continue at home with an outpatient follow-up to assess epithelialization. We studied the duration of the hospital stay, the learning curve of the procedure by the mother, the complications, the duration and the percentage of complete epithelialization and the mortality. RESULTS: A total of 173 giant omphaloceles had a conservative treatment with dissodic 2% aqueous eosin. The average hospital stay was 21 ± 6 days. The learning curve by the mother of the procedure was 10 ± 3 days. Complications of treatment were intestinal functional occlusion 22% and omphalocele sac infection 18%. The complete epithelialization of the omphaloceles sac after application of dissodic 2% aqueous eosin was 68.5%. Mortality was observed in 25.5%. CONCLUSION: Conservative treatment of giant omphaloceles by dissodic 2% aqueous eosin is a simple, efficient and a good alternative to surgery. The mother can easily learn its procedure which reduces the duration of hospital stay.

Epidemiologie des anomalies congenitales dans les centres hospitaliers et universitaires d'Abidjan

Les anomalies congenitales constituent l'une des principales causes de la mortalite infantile dans le monde et particulierement dans les pays en developpement. Objectif principal etait de repertorier toutes les malformations observees dans les trois centres Hospitaliers Universitaires d'Abidjan et a l'institut de cardiologie et les Objectifs secondaires de : - Repertorier leurs caracteristiques epidemiologiques ; - Hierarchiser les pathologies malformatives en fonction de leurs frequences ; - Etablir la mortalite globale de ces pathologies malformatives ; - Etablir la letalite de chacune de ces pathologies malformatives. Patients et methode. Il s'agissait d'une etude retrospective et descriptive sur 10 ans. Les donnees etudiees etaient celles epidemiologiques repertoriees a partir des dossiers medicaux et registres dans les 3 CHU d'Abidjan. Les nouveau-nes de 0 a 28 jours traites pour une anomalie congenitale pendant la periode d'etude etaient la population etudiee. Les donnees ont ete traitees et analysees par les logiciels epi info et Excel. Resultats. De 1996-2006; 1496 nouveaux nes presentant 1589 anomalies congenitales ont ete recenses dans les centres hospitaliers universitaires d'Abidjan. Il s'agissait de nouveau-nes; de meres agees de moins de 35 ans dans 33 des cas; multigestes dans 20 des cas; multipares dans 18 des cas. Les grossesses ont ete regulierement suivies dans 22 des cas et une echographie obstetricale a ete effectuee dans 1 cas sur 4. Le diagnostic prenatal des anomalies congenitales a ete effectue dans 1;5 des cas. Le diagnostic des anomalies congenitales a ete fait dans 79 ;5 des cas a la naissance. Les anomalies congenitales observees etaient : Orthopediques : 33; Neurologiques : 18; Digestives : 14; Faciales : 12;5; Parietales : 12; Urogenitales : 10; Cardiaques : 0;5. - La mortalite globale etait de 52. Les malformations digestives; parietales et neurologiques sont les plus letales Conclusion. les anomalies congenitales existent et sont relativement importantes dans nos structures hospitalieres. Leur diagnostic prenatal reste faible. Elles sont dominees par les anomalies orthopediques. Leur mortalite reste elevee. La mortalite est grevee par une letalite plus importante des pathologies congenitales viscerales

Analyse de 87 dossiers de maladies a caractere professionnel colliges au CHU de Yopougon a Abidjan de 1990 a 2009

Les auteurs rapportent un ca s de pheochro- mocytome ectopique. Cas clinique : patiente de 29ans; hypertendue connue depuis 8ans et diabetique depuis 7ans; admise en urgence pour perte de connaissance. L'examen clinique a montre une pression arterielle a 190/130mmHg; un pouls a 116 battements/minute et un Glasgow a 7 sans deficit hemi corporel. L'examen du fond d'oil a mis en evidence des signes de retinopathie hypertensive stade III. Le dosage plasmatique de la normetanephrine etait de 3917ng/l (normale170) et celui de la metanephrine de 59ng/l (normale73). Le scanner abdominal a montre un processsus tumoral tissulaire para-renal anterieur et polaire superieur gauche; mesurant sur une coupe axiale 73;8 X 51;3mm. Le diagnostic de pheochromocytome a ete pose. Le traitement a consiste a une exerese de la tumeur. L'evolution est favorable. Conclusion : le pheochromocytome para renal est une cause rare d'hypertension arterielle maligne

Infections osteo-articulaires (IOA) des nourrissons de moins de 3 ans: particularites cliniques; bacteriologiques; therapeutiques et pronostiques

Contexte. Dans les pays industrialises; les IoA sont prises en charge tres rapidement au debut des manifestations cliniques contrairement aux pays en developpement ou elles sont traitees tard au stade subaigu ou chronique. L'objectif de cette etude etait de decrire les IAo chez les enfants de moins de 3 ans afin de definir leurs particularites cliniques; d'identifier les bacteries en cause. Patients et methode. Sur une periode de 11 ans; de Decembre 2002 a Janvier 2013; nous avons collige des dossiers d'Infections osteo Articulaires (IoA) d'enfants au Centre Hospitalier Universitaire de Yopougon Abidjan Cote d'Ivoire. Les donnees cliniques concernaient; le delai de consultation; les portes d'entrees; la symptomatologie clinique (signes generaux; signes fonctionnels; signes physiques); Les parametres etudies etaient cliniques; biologiques; bacteriologiques; therapeutiques et evolutifs. Resultats. Au total; nous avons collige 105 dossiers d'Infections osteo Articulaires (IoA) d'enfants de 0 a 36 mois. Les resultats de l'hemoculture ont ete positifs dans 22%; ceux de la ponction articulaire ont ete positifs dans 51;5%; ceux de la ponction metaphysaire dans 22% et ceux du prelevement de la porte d'entree dans 60% . Les bacteries isolees etaient; le staphylococcus aureus dans 54%; Salmonella dans 23%; Klebsiella pneumoniae dans 19%; Pyocianique dans 4%. L'antibiogramme a montre une sensibilite des bacteries isolees dans 100% des cas aux Aminosides; aux Fluoroquinolones; a la Fosfomycine; aux Imipenemes et aux Glycopeptides. La sensibilite aux Betalactamines etait de 60%. Conclusion. Il faut eviter les betalactamines en mono antibiotherapie de premiere ligne au cours des IAo chez les nourrissons de moins de 3 ans. Nous suggerons l'utilisation d'une mono antibiotherapie avec amoxicilline acide clavulanique qui vise l'elimination du Kingella Kingae premiere bacterie en cause au cours des infections orL des nourrissons mais aussi a cause de l'acide clavulanique pour eliminer les staphylocoques dores producteurs de betalactamase

[Primary leiomyosarcoma of adrenal gland, in black African woman: diagnosis and therapeutically aspects]. / Léiomyosarcome primitif de la surrénale chez une noire africaine : aspects diagnostiques et thérapeutiques.

We report a bulky adrenal gland in black woman of 52 years old. This patient was submitted to surgery for resection of the mass. The histopathologic exam found primary leiomyosarcoma of adrenal gland. Beyond twelve month after adrenalectomy, the patient was alive without metastasis.

[Risk factors for rotator cuff injury among dentists]. / Facteurs favorisants de la pathologie de la coiffe des rotateurs chez le chirurgien-dentiste.

CONTEXT: The survey appears in the setting of the politics of improvement for prevention of professional risks in hospital environment in Ivory Coast. PURPOSE: To identify the influence factors of the coif of rotators pathology among dentist surgeons and to improve the preventive measures. TYPE OF STUDY: It was a prospective case/witness survey type. It had for setting, public hospitals and private clinics in Abidjan. METHODOLOGY: We enrolled two types of population (case/witness) comparable with the criteria's of age, sex, bodily mass indication (BMI) and laterality. The data have been collected on a standardized questionnaire named "Nordic questionnaire" and have been enriched. That informed on the bodily mass indication calculated according to the method: weight/T2 (m), on the epidemiological data and the specifics data of the shoulder and the coif of the rotators. The statistical tests have been done by the test of the Khi2 of Pearson, the test of T Student, the exact test of Fischer and the test of the gap reduces. RESULTS: The study included 100 cases and as many witnesses. The middle age of apparition of the tendinitis of the shoulder was of 38,83 years. Age, sex, bodily mass and professional experience didn't have any influence on the apparition of the lesion of the shoulder. The analysis of the results established that the professional seniority encourages the apparition of the lesion of the shoulder. The length on average some seniority is of 12,7 years with extremes of 2 and 30 years. This observation rests on the fact that the risks of intervening of musculo-skeletal unrests of the superior member is equal to the length of work (effort, repetitive acts and stance) returned to the functional capacities. CONCLUSION: The tendinitis of the shoulder, because of its importance must be recognized and repaired as an indemnisable professional disease.

[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.

Transfer of surgical competences in the treatment of intersex disorders in Togo.

BACKGROUND: To evaluate the impact of scientific seminar on the sexual ambiguity on patients and paediatric surgeons in French-speaking African countries. MATERIALS AND METHODS: This was a report of the proceeding of a teaching seminar on intersex management, which was held from December 4 th to 8 th , 2006, in the Paediatric Surgery Department of Tokoin Teaching Hospital and the Surgery Department of "Saint Jean de Dieu" Hospital of Afagnan, Togo. RESULTS: There were 107 participants [five professors of paediatric surgery, 62 African paediatric surgeons (including 15 from African French-speaking countries), and 40 general surgeons]. The workshop involved a two-day theoretical teaching session (aimed at understanding, recognising, and treating the sexual ambiguities), and practical session; during these sessions different intersexes (one case of mixed gonadal dysgenesis, two of female pseudohermaphroditism, and two of male pseudohermaphroditism), were operated free of charge. Participants expressed satisfaction and confidence with regard to the management of intersex after the seminar. CONCLUSION: This scientific forum allowed possible exchange of competence among the paediatric surgeons with regard to efficient treatment of sexual ambiguities.

Transfer of surgical competences in the treatment of intersex disorders in Togo

Background: To evaluate the impact of scientific seminar on the sexual ambiguity on patients and paediatric surgeons in French-speaking African countries. Materials and Methods: This was a report of the proceeding of a teaching seminar on intersex management; which was held from December 4 th to 8 th ; 2006; in the Paediatric Surgery Department of Tokoin Teaching Hospital and the Surgery Department of ""Saint Jean de Dieu"" Hospital of Afagnan; Togo. Results: There were 107 participants [five professors of paediatric surgery; 62 African paediatric surgeons (including 15 from African French- speaking countries); and 40 general surgeons]. The workshop involved a two-day theoretical teaching session (aimed at understanding; recognising; and treating the sexual ambiguities); and practical session; during these sessions different intersexes (one case of mixed gonadal dysgenesis; two of female pseudohermaphroditism; and two of male pseudohermaphroditism); were operated free of charge. Participants expressed satisfaction and confidence with regard to the management of intersex after the seminar. Conclusion: This scientific forum allowed possible exchange of competence among the paediatric surgeons with regard to efficient treatment of sexual ambiguities"

[Compliance with veterinary surveillance orders at the rabies control center in Abijan, Ivory Coast]. / Observance de la surveillance vétérinaire au centre antirabique d'Abidjan.

Rabies remains a major health public health problem in many developing countries. This is particularly the case in the Ivory Coast. Surveillance orders play an important role in patient management. The purpose of this transverse study conducted at Abidjan Rabies Control Center from July 1 to September 30, 2003 was to assess compliance with veterinary surveillance orders by owners of animals that have bitten or scratched persons. Persons reporting to the rabies control center after exposure to the risk of rabies infection and owners of the animals that had bitten, scratched, or licked these persons were included in this study. Most animals involved in these cases (94.8%) were dogs including 69.5% that had been vaccinated. Most persons (71.7 %) at risk reported within two days following exposure and 31.3% provided all three veterinary certificates. The mean time required to provide the first certificate was 4.2 days. The gender of the persona at risk and the vaccination status of the animal involved were correlated with compliance with veterinary surveillance orders. Four main difficulties were cited as hindrances for compliance with veterinary surveillance, i.e., cost (373%), distance (28.4%), time (9.9%), and veterinary clinic accessibility (2.5%). These findings indicate that stricter laws and a national prevention program are needed.

Les traumatismes de l'appareil genito-urinaire : aspects epidemiologiques et lesionnels

Objectif: Analyser la frequence; les etiologies et les types de lesions observees lors des traumatismes de l'appareil urinaire et genital. Patients et methodes: Etude retrospective portant sur 38 victimes de traumatisme de l'appareil genito-urinaire traites entre avril 2000 et decembre 2006 au CHU de Cocody; Abidjan; Cote d'Ivoire. Les parametres etudies ont ete: l'age; le sexe; la profession; les causes des traumatismes; le type de lesions constatees; les interventions chirurgicales realisees l'ensemble repertorie sur des fiches de recueil. Resultats: 38 victimes de traumatisme de l'appareil genito-urinaire ont ete enregistrees sur l'ensemble des 16425 traumatises; soit une prevalence de 0;2. Il s'agissait de 37 hommes et d'une femme avec un age moyen de 26;9 ans (extremes: 5-63 ans). Les patients etaient pour la plupart victimes d'accidents de la voie publique (AVP) (16 cas; 42;1); ensuite 11 patients (28;9) ont eu un accident de travail. Les agressions etaient responsables de 9 victimes soit 23;7des traumatises urogenitaux. Chez 2 patients (5;3) le traumatisme a ete engendre par un accident de sport. L'uretre et la vessie etaient le plus souvent atteints (81;6des cas); pendant que les traumatismes du rein et des organes genitaux externes ont ete observes respectivement dans 7;9et 10;5des cas. 25 cas (65;8) ont eu des fractures de bassin associees. Tous les traumatismes etaient directs dont 29 fermes (76;3) et 9 penetrants (23;78). Les gestes chirurgicaux realises etaient en particulier les uretrorraphies termino-terminales (20 cas; 52;6). Conclusion : les traumatismes de l'appareil uro-genital sont rares; surviennent surtout chez les hommes jeunes victimes d'accidents de la voie publique et de travail. Ces traumatismes peuvent etre responsables de sequelles fonctionnelles invalidantes

[Results of treatment of forearm fractures in the child]. / Resultats du traitement des fractures des deux os de l'avant bras de l'enfant.

OBJECTIVE: To describe epidemiology and to bring back the results of the treatment of the fractures of the forearm fracture. POPULATION AND METHOD: During 3 years and 3 months, we studied the forearm fractures of the children from 0 to 15 years. For each one of them, we studied, the age, the sex, the aetiology and the characteristics of the fracture, the treatment carried out and their evolution. RESULTS: Sixty-nine forearm fractures were listed, the frequency was 23 fractures per years. The sex ratio was 2,63 and the average age was 8 years and 2 months with 13 month and 15 years as extremes. The accidents of play accounted for 93% of the aetiologies. The cutaneous injuries were associated to the fracture in 30 cases (43%). The fractures with displacement was observed in 25 cases (36%), green steak fracture in 21 case (30%), fracture without displacement in 13 case (19%) and other displacements 10 cases (15%). The treatment was orthopaedic (reduction and immobilisation) in 97% of the cases. We observed 3 cases (4%) of secondary displacements under plaster and 6 cases (9%) of the vicious cal. CONCLUSION: The orthopaedic treatment is usually indicated for the Key words: fractures with anatomical restitution. The failures of the orthopaedic treatment need to be treated surgically.

[Epilepsy and employment: a multicentric study of 55 epileptics employed in the public and private sectors in Abidjan]. / Epilepsie et travail: etude multicentrique des conditions de travail de 55 salaries dans les secteurs public et prive a Abidjan.

UNLABELLED: GOAL AND STUDY TYPE: to favour access and job conservation for the epileptic's patients, a descriptive and transversal study of word conditions of epileptic's workers have been driven for June to December 2005 at Abidjan. MATERIAL AND METHOD: study population was constituted of 55 epileptics who are regularly followed and diagnose patients during study period. They did a fixed professional activity employee and old than 15 years. Study was divided in two stapes. The first drive a questionnaire directed. She has completed by an exploitation sentence register of work accident, for balances sheet activities of medical service and filing organization of activities. Variables collected concerned socio-demographic data, medico social structures and the prevention. These data have been treated with soft ware Epi-info 6.0 dfr. RESULTS: the sample was constituted of 35 per cent of men against 35 per cent of women; 80 per cent of epileptics worked a journey and have fixed time and 24 patients, so 43,60 per cent in supplementary hours witch 8 patients (33,33 per cent) have presented an unbalanced of disease. A patient have been victim of work accident (1,8 per cent), 5 cases of cancel responsibility (9,1 per cent have pronounced and 10,9 per cent of patients have changed their job; 17 patients have profit of work stop in year (30,9 per cent). A case of invalidity have pronounced (1,8 per cent). A professional promotion has given at 5 patients (9,10 per cent). The employer was informed of the disease for 58,20 per cent of patient. Two employees have changed attitude after a new attack on their work place. CONCLUSION: the capacity of work of epileptics stay near of a noun epileptic worker for use and functions authorized.

[Experimental study of the influence of the segmental transverse colic reversion on the intestinal transit time]. / Etude experimentale de l'impact de l'inversion d'un segment colique transverse sur le transit intestinal.

OBJECTIVE: to study the feasibility of the transverse segment colic reversion and to evaluate its impact on the intestinal transit time in the rat Wistar. METHOD: On a test group of the rats Wistar males anaesthetized, we isolated a segment from the transverse colon vascularized by a feeder pedicle. This segment colic was reversed and anastomosed into antiperistaltic out of termino-terminal on its site with polyglactine 6/0. Into post-operative, we studied, the weight, the volume of the ingestats, the intestinal transit time, the survival and the histological lesions of the reversed segment colic. On the group controls, we carried out the anastomosis of a segment of the transverse colon isolated and anastomosed into isoperisaltic. RESULTS: Thirty rats males of 231.5 +/- 8.3g had been operated, 15 for the test group and 15 for the control group. The average weight of the ingestats of the rats of the test group was of 21.87 +/- 3g and of 21.75 +/- 4.8g in the control group without significant difference. The intestinal transit occured at 3 +/- 1 post-operatives days in the test group and at 2 postoperative days in the control group. A mechanical obstruction of the bowels before the 15th post-operative day involved a mortality of 87% in the test group. Thirteen percent of the rats of the test group survived, with a regular catch of weight. The histological analysis showed inflammatory lesions on the proximal portion of the reversed segment and a normal wall without ischaemic injury on its distal portion. No death was observed in the group controls. CONCLUSION: The antiperistaltic anastomosis of a transverse segment colic within the colic in the rat Wistar, causes a stop of the intestinal transit time by mechanical occlusion without ischaemic lesion of the segment colic reversed.