[Acute generalized peritonitis in Sominé Dolo's Hospital of Mopti: Epidemiologic and therapeutic aspects]. / Peritonites aiguës Generalisees a l'hopital Somine Dolo de Mopti: Aspects epidemiologique et therapeutique.

Acute generalized peritonitis requires precocious diagnosis and immediate treatment. MATERIALS AND METHODS: The purpose of this study is to determine hospital case frequency, to describe the clinical and therapeutic aspects and to evaluate the operating suites. We conducted a prospective study, lasting 16 months, from January 2005 to April 2006, looking at 40 cases of generalized acute peritonitis operated in several services, including a general surgery department, of the Sominé Dolo's hospital of Mopti. RESULTS: We noted a hospital admittance rate of 3.1% with an average age of 26.3 years old and a 1.66 men to women ratio. Peritonitis at the Sominé Dolo hospital was dominated by intestinal perforation. The diagnosis was essentially made using the clinical approach. The treatment was medico-surgical. Operative mortality was recorded in 7 cases (17.5%) with 7 cases of inner-wall abscesses. The delay of consultations and the Mannheim score were the main factors causing bad prognostics. Excision - sutures associated with a cleansing drainage of the abdominal cavity was the most practised surgical procedure. CONCLUSION: Mortality remains high. The two factors for a bad prognostic are the delay of consultation and the lack of means for reanimation.

INTRODUCTION: La péritonite aiguë généralisée est une urgence qui nécessite un diagnostic précoce et un traitement d'urgence. MATÉRIELS ET MÉTHODES: Nous avons réalisé une étude prospective de seize mois de janvier 2005 à avril 2006 portant sur 40 cas de péritonites aigues généralisées opérés à l'hôpital Sominé Dolo, qui est un hôpital de première référence de la région de Mopti avec plusieurs services dont un service de chirurgie générale. Les objectifs de cette étude étaient de déterminer la fréquence hospitalière, de décrire les aspects cliniques, thérapeutiques et évaluer les suites opératoires. RÉSULTATS: Nous avons eu une fréquence hospitalière de 3,1% avec un âge moyen de 26,3 ans et un sex-ratio de 1,66 pour les hommes. La péritonite à l'hôpital Sominé Dolo de Mopti a été dominée par la perforation intestinale. Le diagnostic a été établi essentiellement sur la clinique. Le traitement a été médico-chirurgical. La mortalité opératoire a été observée dans 7 cas (17,5%) avec 7 cas d'abcès de paroi (17,5%). Le retard de consultation et le score de Mannheim ont été les principaux facteurs de mauvais pronostic. L'excision ­ suture associée à un lavage drainage de la cavité abdominale ont été les gestes chirurgicaux les plus pratiqués. CONCLUSION: La mortalité reste élevée .Les deux facteurs de mauvais pronostic ont été le retard de consultation et le manque de moyens de réanimation.

[Penetrating abdominal wounds caused by weapons in the service of general surgery in the Gabriel Touré teaching hospital]. / Plaies penetrantes abdominales par armes dans le service de chirurgie generale du CHU Gabriel Toure.

INTRODUCTION: Providing care for penetrating abdominal wounds is a controversial subject. The aim of this project was to describe their epidemiological, clinical and therapeutic aspects. MATERIALS AND METHODS: This retrospective study conducted over 4 years, from January 2006 to January 2010 concerned 70 cases of penetrating abdominal injury in the general surgery department of the Gabriel TOURE teaching hospital. Non-piercing and animal horn related abdominal injuries were not included. RESULTS: We collated 70 cases of penetrating abdominal wounds; representing 1.2% of hospitalisations during the studied time frame. The patients were 12 to 59 years old with a mean age of 27.7 years and a sex-ratio of 9 to 1 for men. 27 patients (38.36%) came from districts I and II of Bamako. Criminal injuries was the main cause of injury encountered representing 70% cases. 3 of the patients had psychiatric antecedents and 45.7% of patients regularly consumed drugs. The epiploon and small intestine were the main eviscerated organs (51.4% cases). 17/53 patients received non-surgical treatment. The rate of laparotomia was of 30.2% and postoperative morbidity 15.1%. CONCLUSION: Treating penetrating abdominal injury remains difficult. A good selection of patients allow the service to lower the rate of laparotomia.

INTRODUCTION: La prise en charge des plaies pénétrantes de l'abdomen est encore sujet à controverses. Les objectifs de ce travail étaient d'étudier les aspects épidémiologiques, cliniques et thérapeutiques. MATÉRIELS ET MÉTHODE: Cette étude rétrospective de 4 ans, de janvier 2006 à janvier 2010 portant sur 70 cas de plaies pénétrantes de l'abdomen, a été réalisée dans le service de chirurgie générale du CHU Gabriel Touré. Les plaies non pénétrantes et les encornements ont été non inclus. RÉSULTATS: A l'issue de l'étude, nous avons colligé 70 cas de plaies pénétrantes abdominales;ce qui a représenté 1,2% des hospitalisations. L'âge moyen des patients a été de 27,7 ans(extrêmes 12 et 59 ans) avec un sex ratio de 9 pour les hommes. Vingt sept patients (38,36%) viennent de la commune I et II. L'agression criminelle a été la circonstance de survenue la plus fréquente (70%). Trois de nos patients avaient un antécédent psychiatrique et 45,7% consommaient des stupéfiants. L'épiploon et le grêle ont été les organes les plus éviscérés (51,4%).Dix sept patients sur 53 ont bénéficié du traitement non opératoire. Notre taux de laparotomie blanche a été de 30,2% et la morbidité post opératoire était de 15,1%. CONCLUSION: La gestion des plaies pénétrantes abdominales reste difficile. Une bonne sélection des patients permet de diminuer le taux de laparotomie blanche.

[Epidemiologic and therapeutic factors of postoperative incisional hernia at CHU Gabriel Touré]. / Facteurs etiologiques et therapeutiques des eventrations postoperatoires au Chu Gabriel Toure.

INTRODUCTION: The incisional hernia is a frequent complication of the opened abdominal surgery. The objectives of this study were to determine the hospital frequency and the favoritizing factors, to analyze the therapeutic aspects. MATERIALS AND METHODS: We realized a retrospective study from January, 1999 to December, 2005 in the services of general and paediatric surgery of teaching hospital Gabriel Touré. It concerned 45 cases of incisional hernia. The hernias of the abdominal wall, the abdominal and traumatic hernia were not retained. RESULTS: The frequency was 0.52%; the average age of our patients was 37.8 years with a sex ratio of 2 in favour of the woman. The average delay of consultation was of 59 months with extremes going from 2 to 11 months. Favoritizing factors found were the parietal suppuration to 13 (28.8%) patients and the multiple interventions to 8 (17.8%) patients. The average dimension of the hernia was 9.5 cms ± 3.8 with extremes going from 5 to 14 cms. The 45 patients benefited from the cure of the hernia according to Mayo. We didn't lost any patient. 2 parietal suppurations happened post-operatively. CONCLUSION: Incisional hernia treatment consists for Mayo's method or prosthesis. The laparoscopic surgery can reduce complications.

[Omphalocele in general and pediatric surgery in Gabriel Touré]. / Traitement des Omphaloceles Dans les Services de Chirurgie Generale et Pediatrique du Chu Gabriel Toure.

INTRODUCTION: the omphalocèle is an evolution of the extra embryonic coulombs between the 32th and the 72th days of the pregnancy. The treatment depends on his volume. In Mali; few works were published on the omphalocèle and its treatment. MATERIALS AND METHOD: we brought together 111 cases of omphalocèles during 8 years of study with the aim of determining the epidemiological factors and describing the clinical and therapeutic aspects. RESULTS: 49 patients on 111 were of the male and aged between 4,2 days with weight between 2500 - 3500 g. The diameter of the r snare was superior to 8 cms in 29(26,13%) cases and has benefited a conservative treatment according to Grobb. 13 patients had a rupture of the membrane. The liver has been found in 29 time (26,13%) in the sac and 35 case and associated malformation. 20 cases of death have been observed. Antenatal ultrasound found exomphalos in 9 cases. Any mother had a story of teratogenic medications and 67 mothers were multipared. CONCLUSION: Omphaloceles are multidiscipli-nary surgical emergencies. Antenatal echogra-phy is useful for the antenatal diagnosis.

Enzyme-linked immunosorbent assay (ELISA) for steroid hormones with polyclonal and monoclonal antibodies: an assay for urinary aldosterone.

The development of non-competitive microtitre plate enzyme-linked immunosorbent assays for steroids was investigated using immobilised steroid as immunosorbent and enzyme-labelled second antibodies. An assay for testosterone with polyclonal anti-testosterone immunoglobulins was optimised with respect to a number of parameters but remained unsatisfactory for clinical assays. The results were applied to developing an aldosterone assay using monoclonal anti-aldosterone immunoglobulins. The latter method was used for the determination of urinary aldosterone and the results are compared with those obtained by a classical radioimmunoassay. Problems concerned with the use of sulphur-containing proteins and with the presence of low affinity antibodies in polyclonal preparations are discussed.