Posterior approach for surgical treatment of neglected elbow dislocation.

INTRODUCTION: Neglected elbow dislocations often result in contracture and functional impairment. Surgical treatment is challenging because of the accompanying triceps retraction. We wanted to share our experience in treating these neglected dislocations using the posterior approach. PATIENTS AND METHODS: This was a consecutive, prospective study over a 4.5-year period (January 2003 to June 2007) that included all the patients who presented with a neglected elbow dislocation that was older than 21 days. We treated 22 patients (17 men, five women) with an average age of 22.8±8.2 years (range 14 to 46 years). The dislocations were 8.5±4.2 months old on average (range 2 to 17 months). Average elbow flexion was 46.0°±25.9° (10° to 90°) and the extension deficit was 19.5°±18.4° (0° to 60°) before the surgery. A paratricipital approach was used in all patients. In 14 patients, the dislocation was reduced without triceps lengthening. In eight patients, a V-Y plasty of the triceps muscle was required. RESULTS: The average follow-up was 21 months (range 12 to 30 months). The improvement in the overall range of motion was statistically significant. Average elbow flexion was 112.7°±13.3° (60° to 130°) and the extension deficit was 26.6°±17.0° (0° to 60°). The average Mayo Clinic Elbow Performance Index score was 86 (range 50 to 100), with 14 excellent, four good, two average and two poor results. Complications included three cases of ulnar nerve paresis, which subsided within three months, and one case of superficial infection. DISCUSSION: Although surgical treatment is challenging, the functional improvement in neglected elbow dislocations is outstanding. The best functional results can be expected when the triceps splitting approach to the elbow is not used. LEVEL OF EVIDENCE: IV.

[Immunodiagnosis of Fasciola gigantica fascioliasis by ELISA technique in Senegal. Preliminary observations in 2 lambs]. / L'immunodiagnostic de la fasciolose à Fasciola gigantica par la technique ELISA au Sénégal. Observations préliminaires chez deux agneaux.

The purpose of this work was to investigate the use of the ELISA test for the diagnosis of fasciolosis (Fasciola gigantica) in sheep, in Senegal, using Fasciola gigantica metabolic excretion-secretion products as antigens. Coprological analysis results were negative until the fourteenth week following infection; using the ELISA test, the first anti-Fasciola gigantica antibodies can be detected as early as the fourth week following infection.

[Epidemiology of intestinal schistosomiasis with Schistosoma mansoni in Richard-Toll (Delta of the Senegal River). Malacological study]. / Epidémiologie de la bilharziose intestinale à Schistosoma mansoni à Richard-Toll (Delta du fleuve Sénégal). Etude malacologique.

A recent outbreak of intestinal schistosomiasis (1989) has been reported in Richard-Toll (Delta of Senegal River) with a global prevalence of 43%. A malacological survey has been carried in order to study, the density of Biomphalaria pfeifferi the intermediate hosts, their distribution and rate of infection, and to identify the transmission sites. Ten districts have been selected. The snails have been collected in the different water points of these localities which are the river, the Taouey marigot, the Taouey channel and the irrigation channels and drains of the CSS (Senegal Sugar Company). A total of 1,210 Biomphalaria have been collected in 45 sites with a variable density of 2 to 150 snails. The overall rate of infestation of snails is 44% but varies according to the districts (9 to 64%). The transmission is acting in all the districts mainly in the Taouey channel (28% of infested snails) the Taouey marigot (38% of infested snails) and particularly in the channels of CSS (47% of infested snails). The situation is alarming and requires urgent action be undertaken to decrease the prevalence and reduce the transmission.

[Resistance to drought of mollusks of the genus Bulinus, vectors of human and animal trematode infections in Senegal. II. Study under natural conditions in the North-Sudan area. Ecology and resistance to drought of Bulinus umbilicatus and B. senegalensis]. / Résistance à la sécheresse de mollusques du genre Bulinus vecteurs de trématodoses humaines et animales au Sénégal. II. Etude dans les conditions naturelles en zone Nord-soudanienne. Ecologie et résistance à la sécheresse de Bulinus umbilicatus et B. senegalensis.

The authors report on the results of a 2-year study on the ecology and resistance to drought of B. umbilicatus and B. senegalensis on 3 temporary ponds in the North-Sudan area (region of Tambacounda, Senegal). The variations in some abiotic factors like the temperature and the pH of water do not seem to have a strong influence on the ecology while rainfall has a great importance on the distribution and the density of molluscs. As a fact, the quantity of water and the drying out period of these ponds depend upon rain factors which rule the existence and the survival of the malacological fauna. In the second part of the rainy season, the population reaches its maximum, i.e., during the reproduction period. Monthly observations show that the relative abundance of B. umbilicatus is higher than that of B. senegalensis. These ponds are dry during 6 to 8 months per year. However the populations of molluscs regenerate regularly, a fact which presupposes a certain ability to resist drought. Some come through this period successfully, but the middle-sized ones (7 to 9.9 mm) resist better than others (70 to 80 per cent of the population). Immediately after the first rains they resume their activity and lay intensively in order to reconstitute the population. B. umbilicatus and B. senegalensis are potential intermediate hosts for human and animal trematode infections, but in the studied region only B. umbilicatus intervenes in the transmission of S. haematobium and S. curassoni which occurs between September and November. Under natural Sahel conditions the epidemiological cycle is short and everything happens within 4 to 6 months with the regeneration and the growth of the population of molluscs, its infestation and the transmission of trematode infections. The ecological behaviour of these molluscs in the North-Sudan region is very important in the epidemiology of human and animal trematode infections and requires a new controlling strategy. The destruction of molluscs is more effective and more economic at the end of the rain season, which is the beginning of the drying of ponds, a period in which they concentrate in the residual water pools.