[Calibrated sleeve gastrectomy or sleeve gastrectomy: experiences in Abidjan]. / Gastrectomie longitudinale calibree ou sleeve gastrectomie: experience Abidjanaise.

INTRODUCTION: The aim of this study was to evaluate and analyze the first 29 cases of sleeve gastrectomy in Abidjan. PATIENTS AND METHODS: We analyzed the records of patients operated for morbid obesity in 3 private clinics in Abidjan by the team of Professor Alexandre N'Guessan from 2009 to 2014. This study included all patients who underwent laparoscopic sleeve gastrectomy for morbid obesity. RESULTS: A total of 29 patients were operated; 28 women and 1 man with a mean age of 34 years. Their body mass index (BMI) ranged between 35 and 49 kg/m2 with comorbidities. The laparoscopic procedure was possible in all cases without conversion. The average operative time was 3 hours. Patients were exeat in 70% of cases in the second postoperative day after methylene blue checks were conducted. Only 4 complications (1 phrenic abscess, 1 small bowel obstruction, 1 gastric stenosis and 1 digestive fistula) required surgical recovery. The operative mortality was 6.89%. Around 92.85% of patients had a loss of excess weight greater than 50% over 4 years, with an improvement of comorbidities. CONCLUSION: The sleeve gastrectomy is a feasible technique with our current working conditions. It requires a good patient selection, and a multidisciplinary team.

INTRODUCTION: Le but de ce travail a été d'évaluer et d'analyser les 29 premiers cas de sleeve gastrectomie à Abidjan. PATIENTS ET MÉTHODES: Nous avons évalué le dossier des patients opérés pour obésité morbide dans 03 cliniques privées d'Abidjan par l'équipe du Pr N'Guessan Alexandre de 2009 à 2014. Ont été inclus tous les patients ayant bénéficié d'une sleeve gastrectomie laparoscopique pour obésité morbide. RÉSULTATS: 29 patients ont été opérés; 28 femmes et 1 homme avec un âge moyen de 34 ans. L'indice de masse corporelle (BMI) compris entre 35 et 49 Kg/m2 avec des comorbidités. La procédure laparoscopique a été possible dans tous les cas sans conversion. La durée opératoire moyenne était de 3h. Les patients étaient exéat dans 70% des cas au 2ème jour post opératoire après un contrôle au bleu de méthylène. Quatre (4) complications (1 abcès sous phrénique, 1 occlusion du grêle, 1 sténose gastrique et 1 fistule digestive) ont nécessité une reprise opératoire. La mortalité opératoire était de 6.89%. environ 92,85% des patients avaient une perte d'excès de poids supérieure à 50% sur 4 ans, avec une amélioration des comorbidités. CONCLUSION: La sleeve gastrectomie est une technique réalisable dans nos conditions de travail. Elle nécessite une bonne sélection des patients, une équipe multidisciplinaire.

Gastrectomie longitudinale calibrée ou sleeve gastrectomie : expérience abidjanaise

Introduction : Le but de ce travail a été d'évaluer et d'analyser les 29 premiers cas de sleeve gastrectomie à Abidjan. Patients et Méthodes : Nous avons évalué le dossier des patients opérés pour obésité morbide dans 03 cliniques privées d'Abidjan par l'équipe du Pr N'Guessan Alexandre de 2009 à 2014. Ont été inclus tous les patients ayant bénéficié d'une sleeve gastrectomie laparoscopique pour obésité morbide. Résultats : 29 patients ont été opérés ; 28 femmes et 1 homme avec un âge moyen de 34 ans. L'indice de masse corporelle (BMI) compris entre 35 et 49 Kg/m2 avec des comorbidités. La procédure laparoscopique a été possible dans tous les cas sans conversion. La durée opératoire moyenne était de 3h. Les patients étaient exéat dans 70% des cas au 2ème jour post opératoire après un contrôle au bleu de méthylène. Quatre (4) complications (1 abcès sous phrénique, 1 occlusion du grêle, 1 sténose gastrique et 1 fistule digestive) ont nécessité une reprise opératoire. La mortalité opératoire était de 6.89%. environ 92,85% des patients avaient une perte d'excès de poids supérieure à 50% sur 4 ans, avec une amélioration des comorbidités. Conclusion : La sleeve gastrectomie est une technique réalisable dans nos conditions de travail. Elle nécessite une bonne sélection des patients, une équipe multidisciplinaire

The diagnostic value of indirect ultrasound signs during acute adult appendicitis.

PURPOSE: To evaluate the diagnostic value of indirect ultrasound signs during acute appendicitis. PATIENTS AND METHODS: Our retrospective study lasted 5 years, from May 2005 to April 2010. It concerned 620 cases of appendectomy performed following prior ultrasound examination of the right iliac fossa (RIF). In 448 cases, ultrasonography clearly showed the appendix, which was inflamed. The presence of indirect signs of appendix inflammation without visualisation of the appendix was confirmed by ultrasound examination in 160 cases. In 12 cases, the appendix was not visualised nor were there any indirect signs on the ultrasound image. The indirect signs involved were hypertrophy of the peritoneal fat (HPF), pain caused by compression on exploration of the right iliac fossa, and localised hypokinesia in the digestive loops (LHL). We compared the results found by ultrasonography with the operative and anatomical pathology reports. RESULTS: The positive predictive value of the indirect signs of appendicitis on the ultrasound scan was 95.8% if the three indirect signs were associated, 87.5% for the association of pain and HPF, 45.8% for the association of pain and LHL, and 25% if there was just pain. The negative predictive value of the indirect signs of appendicitis on the ultrasound scan was 57.2% if the three signs were associated, 65.9% for the association of pain and HPF and 60.7% for the association of pain and LHL, with 83.3% for pain alone. The sensitivity of the indirect signs was 83.9% if the three signs were associated, 31.8% for the association of pain and HPF, 50% for the association of pain and LHL, and 50% if there was just pain. The specificity of the indirect signs was 85.7% if the three signs were associated, 96.7% for the association of pain and HPF, 56.7% for the association of pain and LHL, and 62.5% if there was just pain. CONCLUSION: When tomodensitometry cannot be performed and the appendix is not visible on ultrasound examination, indirect ultrasound signs must be systematically sought, particularly in populations in which appendicitis are highly prevalent.

[Radiologic aspects of traumatic lesions of the cervico-occipital junction]. / Les aspects radiologiques des lesions traumatiques de la charniere cervico-occipitale.

INTRODUCTION: Traumatic lesions of cervical spine are common, but those of the cervico-occipital junction are less frequent but more serious. PURPOSE: Evaluate the radiological aspects of cervico occipital Junction traumatisms. METHODS: It is a retrospective study of 32 files of cervico occipital junction traumatisms, collected from January 1995 to December 2004. Imaging methods used were: conventional radiography and computed tomography. RESULTS: Cervico occipital junction traumatisms were less common. They account for 12.7% of cervical spine traumatisms and 0.64% of the admissions. Patients mean age was of 36 years with a male predominance of 81%. Main etiologies were public highway accidents (66%), falls (7%), sports accidents (6%). Bone lesions were most frequent, dominated by fractures of the axis (58%), followed by those of the atlas (24%) and of the occipital bone (5%). Dislocations were observed in 10 patients. Basilar print was observed in two patients who deceased. Polytrauma was observed in 34% of the patients. CONCLUSION: Cervico occipital junction traumatisms are severe and uncommon in hospitals because of their high lethality. CT is most effective for analyzing lesions.

[Appearance on X-ray and computed tomography of femoral head necrosis in patients with sickle cell disease]. / Aspects radiographiques et tomodensitométriques de la nécrose de la tête fémorale chez le drépanocytaire.

The aim of this study was to describe X-ray and computed tomography signs and to estimate the severity of femoral head necrosis in patients with sickle cell disease. We studied two groups of patients with sickle cell disease (group A: 14 patients with no hip pain and group B: 34 patients with hip pain) over 17 months. Each patient underwent hip X-ray (lying face-down) and CT scan. None of the patients in group A presented hip lesions whereas we detected 42 necrotic femoral head lesions by standard X ray and 51 by CT scan. The lesions were frequently bilateral (82.14%) and were more frequent in young patients (from 11 to 30 years old). Their progression was faster in patients with the SS genotype. No significant difference was observed according to type of hemoglobin. All patients with sickle cell disease presenting with hip pain should undergo CT scan to check for femoral head necrosis.

[Ultrasound aspects of abdominal involvement in adults with HIV infections in the Ivory Coast: apropos of 146 cases]. / Aspects échographiques des atteintes abdominales au cours de l'infection à VIH chez l'adulte de Côte d'Ivoire: à propos de 146 cas]

Over a six-month period, 146 grade IV AIDS patients (HIV-1 and HIV-2) systematically underwent abdominal ultrasound examination. All abdominal organs were investigated in the search for lesions. Many lesions were detected. Pathological lesions were most frequent in the nodes (17.2%), hyperechogenic liver tissue (16.5%) and kidneys (13.7%). Lesions in the liver, gall bladder and spleen were less frequent. In most cases, the lesions were not specific to AIDS. However, systemic abdominal ultrasound scans for AIDS patients would be of value because such lesions are present.

[Contribution of computed tomography in the diagnosis of symptomatic epilepsy]. / Apport de la tomodensitométrie dans le diagnostic étiologique des épilepsies symptomatiques.

The aim of this retrospective study was to document the various causes of epilepsy determined by computed tomography (CT). We studied 205 CT scans carried out in patients with symptomatic epilepsy. We identified 52 (25.36%) pathological causes: 18 cases (34.62%) of infectious lesions, predominantly toxoplasmosis, 9 cases (17.30%) of tumors, 9 cases (17.30%) of vascular lesions and 8 cases (15.39%) of post-traumatic and atrophic lesions. CT is of great value in the diagnosis of epilepsy, not only in the assessment of the disease, but also for identifying the lesion responsible for the seizures, which may be treatable. It is advisable to carry out a CT scan for any patient presenting with symptomatic epilepsy.

[Radiographic aspects osteoarticular complications in Buruli ulcers]. / Aspects radiographiques des complications ostéo-articulaires dans l'ulcère de Buruli.

The authors examine radiographic aspects of osteo-articular and soft tissue lesions on the basis of 30 files of in-patients suffering from Buruli ulcers. They specify the chronology and precociousness of certain signs: soft tissue lesions, bone demineralization, periostal apposition two months after the beginning of signs, and later osteolysis and joint complications. These lesions are not specific and occur contiguously to soft tissue lesions. The authors specify the part of secondary-infection germs in the appearance of bone lesions.

[A case of asplenia in a sickle cell homozygote SS patient]. / Un cas d'asplénie chez un drépanocytaire homozygote SS.

One case of total splenic atrophy is reported in a patient with SS homozygous sickle-cell disease presenting no related malformation, thus recalling the IVEMARK syndrome. An abdominal echography and computed tomography are indispensable in order to confirm the absence of the anatomic spleen; this makes for a better follow-up of sickle-cell disease.

[Intra-abdominal small round-cell desmoplastic tumor: ultrasonographic and computed tomographic aspects. Apropos of a case]. / Tumeur desmoplastique intra-abdominale à petites cellules rondes: aspects échographiques et tomodensitométriques. A propos d'un cas.

We report a case of small round-cell desmoplastic tumor located in the abdomen. We describe the ultrasound and CT features of this uncommon tumor with poor prognosis.

[Ultrasound diagnosis of fetal malformations in utero: apropos of 30 cases]. / Diagnostic échographique des malformations foetales in utero: à propos de trente cas.

This study assess the incidence of fetal malformations and the contribution of ultrasound scans to their diagnosis in utero. We reviewed the files of 1,960 pregnant women of whom 30 (1.53%) had malformed fetuses. Ultrasound scanning detected 29 of these cases and failed to detect only one case (an arterial canal malformation). Neurological malformations, particularly hydrocephalus and anencephaly, were most common (12 cases), followed by urinary tract abnormalities (hydronephrosis and renal polycystosis). Other malformations, such as those of the digestive tract, thorax and face, occurred less frequently. Ultrasound scans can be used to decide whether the pregnancy should be continued and what postnatal treatment should be given.

Complications après usage de produits de la pharmacopée traditionnelle (aspects cliniques)

Les intoxications après usage de préparations de la pharmacopée traditionnelle sont graves. Les auteurs ont identifié 4 tableaux cliniques. Ils déplorent l'importante mortalité et pensent qu'une évaluation rationnelle de ces produits permettrait outre la sécurité de l'usage, le traitement ciblé des intoxications

[Ultrasonically guided fine needle biopsy in the diagnosis of malignant liver tumors]. / Cytoponction à l'aiguille fine échoguidée dans le diagnostic des tumeurs malignes du foie.

Ultrasonography can be used to guide fine needle biopsy of suspected malignant liver lesions. In Abidjan this method allowed cytologic identification of 63 liver lesions disclosed by ultrasonography. In 53 cases (84%) including 41 hepatocarcinomas, 4 Burkitt's lymphomas, and 8 metastases, cytology confirmed malignancy. In 10 cases, initially supposed to be hepatocarcinomas (6 cases) or metastases (4 cases), cytologic findings led to a different diagnosis of either cirrhosis, abscess, or necrotic tissue (4 cases). No complications were observed in this series of 63 ultrasonically guided biopsies. This safe, easy, sensitive, and cost-effective technique should be used to identify the solid tumors. This indication is common in Black Africa where these tumors are common.

Lymphagiome kystique cervical: apport de l'echographie et de la tomodensitometrie: a propos d'un cas. [Lette]

Les auteurs; a partir d'un cas de lymphagiome kystique cervical; signalent l'apport de l'imagerie medicale; surtout de l'echographie et la tomodensitometrie; dans le diagnostic de cette affection rare

[Morphometry of the prostate in Black Africans. Apropos of 300 cases]. / Morphométrie de la prostate chez le Noir Africain. A propos de 300 cas.

Sus-pubic route real time echographic, has allowed to determinate prostatic dimensions (antero-posterior, diameter, APD; mean transversal diameter: MID, cranio candal length CCL) volume and weight in the Black African on 300 subjects. The mean values of these parameter do not differ from European an American values. They increase progressively with age. They are higher in subjects presenting with history of affection of the urinary tract (especially gonococcus urethritis).