[Labial fusion in the paediatric surgery department of Yopougon University hospital (Côte d'Ivoire): 108 cases]. / La coalescence des nymphes au service de chirurgie pédiatrique du CHU de Yopougon : à propos de 108 cas.

INTRODUCTION: Labial fusion is a benign genital disorder in girls. It may be either congenital or acquired, sometimes due to poor hygiene. Parental panic about this "absent vagina" contrasts with its simple, rapid, radical treatment. The study reports the result of simplified treatment. MATERIAL AND METHODS: This retrospective study covers cases from 1 January 1992 through 31 December 2006 and includes only the cases of young girls treated as outpatients. All patients underwent outpatient surgical treatment. They were placed in gynaecological position. After asepsis of the vulva, a curved Halsted mosquito forceps was inserted into the opening for partial adhesions or across the medial transparent membrane for complete fusion. The forceps were then opened gently until complete detachment occurred. Local anaesthesia with EMLA cream ensured the absence of pain; there was sometimes minimal bleeding. All patients had local antiseptic treatment afterwards. RESULTS: During this study period, 108 patients (including two sisters) with a mean age of 22 months were treated for labial fusion (101 cases of total fusion and 7 partial). Only seven were older than 5 years of age. Overall, 84 patients underwent this basic treatment of section and follow-up antisepsis; none had a recurrence. Twenty girls also received oestrogen cream, and 4 had the surgical section alone. DISCUSSION: This benign disorder is rare and generally isolated in our regions, unlike in Western countries where it is often associated with hormonal deficits. The principal approach has been either therapeutic abstention or oestrogen therapy, both currently recommended in developed countries. Oestrogen treatment is a long procedure (3 or 4 months), however, and follow-up is far from certain. In Africa, all genital disorders are considered serious. Early repair is desirable for that reason and to prevent urinary tract infections and traditional "treatment". Simple outpatient treatment by surgical section with local antiseptic treatment is effective. Vulvar hygiene is essential to prevent recurrence. CONCLUSION: This benign disorder can be treated by any physician, but the psychological impact of the site and the necessary speed suggest the choice of management in paediatric units.

[Treatment of complicated childhood osteomyelitis at Yopougon University Hospital, Abidjan (Côte d'Ivoire)]. / Traitement des ostéomyélites compliquées de l'enfant au CHU de Yopougon, Abidjan (Côte d'Ivoire).

BACKGROUND: Complicated osteomyelitis in children is difficult to treat and can lead to important functional sequelae. OBJECTIVE: To report epidemiological, clinical and diagnostic aspects as well as treatment and outcome of complicated osteomyelitis in children. PATIENTS AND METHODS: This retrospective study of complicated osteomyelitis cases treated from March 2000 through March 2004 in the orthopedics unit of the Yopougon University Hospital in Yopougon identified 42 children with complicated osteomyelitis (defined as all acute osteomyelitis lesions that developed any complications). We examined the following types of variables : epidemiologic (age, sex, ethnic origin), clinical (fever, type of complication), diagnostic (full blood count, C-reactive protein, bacteriological, radiological) treatment (antibiotic treatment, surgical and orthopedic treatment), and outcome (cure, sequelae). RESULTS: The sex-ratio was 1:1, and mean age at first consultation in our specialized unit was 7 years and 5 months. Thirty per cent of the children were referred from the haematology unit. The ethnic origin of 60% was Malinke (northern Côte d'Ivoire). Time from initial signs to first consultation in our unit averaged 7 months and ranged from 5 days to 5 years. Fever of 38.5 degrees C or higher was reported for 60% of the children; 32 children (76%) presented osteomyelitis fistula, 10 (24%) osteomyelitis without fistula, and 10 a hemoglobinopathy. Radiography revealed pathological fractures in 13 (31%) cases, sequestrum in 17 (41%), and diaphysitis in 12 (28%). Lesions were found predominantly on the femur and humerus. Staphylococcus aureus and Salmonellae spp. were the principal bacteria involved. Third-generation cephalosporins were combined with aminoglycosides for 19 cases (60%) of osteomyelitis fistula and 3 cases (30%) of febrile osteomyelitis without fistula. Surgical treatment was fistulectomy in 94% of the cases of osteomyelitis fistula and sequestrectomy in 47%. More than half the pathological fractures were treated by immobilization in plaster, and sequestrum was restored by immobilization in plaster in 7 cases. The principal sequela was axial displacement of the limb. CONCLUSION: Complications of acute osteomyelitis are most often caused by diagnostic errors that delay treatment. Surgical treatment of the two principal lesions (fistula and bony sequestrum) followed by combination antibiotic therapy and completed by immobilization in plaster ensures complete recovery in more than half the cases.