Endoscopic surgery in Senegal. Benefits, costs and limits.

BACKGROUND: Evaluating the introduction of endoscopic surgery in Senegal may be useful for assessing the role of this technology in developing countries. METHODS: The endoscopic surgery performed at the Hospital Principal and the Hospital Le Dantec, Dakar, from January 1995 to December 2000 was evaluated retrospectively. Operative time, postoperative stay, patients, and hospital costs were compared in samples of 100 patients treated endoscopically and 80 patients treated with open techniques. RESULTS: Altogether, 826 endoscopic procedures were performed (11.6% of elective surgical activity). Of these, thoracoscopic (34%) and laparoscopic (14%) vagotomy, cholecystectomy (21%), fundoplication (12%), and diagnostic laparoscopy (11%) were selected for comparisons. Operative time proved to be reduced by endoscopic surgery except for laparoscopic fundoplication (+40 min). After endoscopic surgery, postoperative hospitalization was 3.7 days shorter, and patient fees were consequently reduced. In 6 years, 87% of the hospital investment (36,000 Euro) was recovered. CONCLUSIONS: Developing countries can benefit from endoscopic surgery. First-world countries might supply staff training.

[Salmonella enteritidis splenic abscess complicating a Plasmodium falciparum malaria attack]. / Abcès splénique à Salmonella enteritidis compliquant un accès palustre à Plasmodium falciparum.

INTRODUCTION: Salmonella splenic abscesses are rare and usually occur on pre-existing lesions. OBSERVATION: A Moorish 16 year-old woman from Senegal presented with a S. enteritidis abscess without any factor other than an attack of P. falciparum malaria. Treatment associated quinine salts, antibiotherapy and splenectomy. COMMENTS: P. falciparum malaria attacks not only induce humoral and then cellular immunodepression but are also at the origin of infarction or splenic hematoma that may enhance bacterial infection and the development of abscesses. Splenectomy or percutaneous drainage associated with antibiotherapy is the usual treatment for splenic abscesses. Prognosis remains severe (13 to 16% mortality).

[A case of nasal entomophtoral phycomycosis observed in an arid African region (Somalia)]. / A propos d'un cas de rhino-entomophtoro-phycomycose observé en zone sèche Africaine (Somalie).

On the African continent, rhinophycomycosis entomophtorae, a deep mycosis due to Conidiobolus coranatus, has been encountered mainly in wet forest areas. Only one case, which involved a Tchadian, has been reported in a dry zone. The present report describes a case observed in a 30-year-old Somalian, who lived all his life in the rural zone of Dinsoor where the climate is hot (temperature between 22 degrees C and 30 degrees C) and dry (annual rainfall less than 400 mm). In this patient, diagnosis was based on the presence of a characteristic bifocal deformation of the central region of the face and on histological findings typical of rhinophycomycosis entomophtorae. This case underlines the fact that this deep mycosis can occur outside of wet forest areas in Africa. Thus practitioners should not rule this diagnosis out simply on the basis of climatic conditions.

[Peritoneal puncture dialysis in the monitoring and treatment of hemoperitoneum of traumatic origin?]. / Ponction dialyse péritonéale dans la surveillance et le traitement des hémopéritoines d'origine traumatique?

The great diversity of injuries after abdominal wound, need an adapted treatment. When laparotomy is indicated in uncontrollable hemorrhage, peritoneal lavage associated with C.T. scan seems to be interesting in the management of hemoperitoneum with a moderate injury severity score and stable arterial and venous pressures. Three patients were recently managed non operatively with good results. The authors draw up these three cases with inclusion criterias and limits of the method.

[Mechanical anastomosis on the second duodenum. Value, technics and indications]. / Anastomoses mécaniques sur le deuxième duodénum. Intérêt, techniques et indications.

The authors present 50 anastomoses on the second part of duodenum after gastrectomy, that were done for gastro-duodenal ulcer in 24 patients, gastric carcinoma for 20 patients and post-gastrectomy syndromes in 5 patients. The mechanical procedure provide excellent security (without leakage) and was easy to perform. When it is necessary to make the restoration of duodenal continuity, this device is a good technical solution.