[Infections associated with the care in the department of gynecology - obstetrics of the University Hospital Center Gabriel Touré]. / Les infections associees aux soins dans le departement de gynecologie ­ obstetrique du Centre Hospitalier Universitaire Gabriel Toure de bamako, mali.

OBJECTIF: the purpose of this work was to study the infections associated with the care in the department of gynecology - obstetrics of the University Hospital Center Gabriel Touré (CHU G. Touré). PATIENTS AND METHODS: This was an epidemiological, descriptive, and analytical study carried out in the gynecology-obstetrics department of G. Touré University Hospital, from April 11, 2016 to August 29, 2016 (4 monthset 18 days), with a prospective collection of data that focused on the characteristics clinical and laboratory-based care-associated infections in patients during their hospitalization. Included in the study were all hospitalized patients (operated or not) in the gynecology obstetrics department, who agreed to participate in the study. The criteria used to diagnose the infection associated with care were those of the CDC Atlanta and making a thick drop in our context. Operative wound monitoring was performed until the 30th postoperative day. RESULTS: We recorded 200 patients, including 138 operated and 62 nonoperated patients, of which 30 patients developed a care-associated infection at a rate of 15%. The mean age of the patients who presented an infection was 32.52 years ± 13.36 years against 29.36 years ± 10.28 years for the patients who did not present the infection. Seven point five percent of the evacuees had an infection associated with care. The most common types of infections were surgical site infection with 56.60% followed by malaria with 23.30% and urinary tract infection with 20.00%. Escherichia coli and Acinetobacter baumaniiwere the most recovered germs. Isolated organisms were 100% resistant to Amoxicillin, 88.88% were resistant to Ciprofloxacin and 77.77% were resistant to Amoxicillin + Clavulanic acid. The average duration of hospitalization for patients who developed the infection was 14.70 days with extremes of 5 and 46 days. The mortality rate was 1.50%. The average cost of management of patients who developed the infection was 119837 FCFA; the extremes were 17750 and 825750 FCFA and the standard deviation of 174998 CFA francs. CONCLUSION: the infections associated with the care remain frequent in our service and dominated by the infections of the operating site. The isolated organisms were all 100% resistant to Amoxicillin in 88.88% Ciprofloxacin.

LE BUT: de ce travail était d'étudier les infections associées aux soins dans le département de gynécologie ­obstétrique du Centre Hospitalier Universitaire Gabriel Touré (CHU G. Touré). PATIENTES ET MÉTHODES: Il s'agissait d'une étude épidémiologique, descriptive, analytique réalisée dans le département de gynécologie ­obstétrique du CHU G. Touré, allant du 11 Avril 2016 au 29 Août 2016 (4 mois et 18 jours) à collecte prospective des données qui a porté sur les caractéristiques cliniques et biologiques des infections associées aux soins chez les patientes au cours de leur hospitalisation. Etaient incluses dans l'étude toutes les patientes hospitalisées (opérées ou non) dans le service de gynécologie obstétrique, et qui ont accepté de participer à l'étude.Les critères utilisés pour le diagnostic de l'infection associée aux soins étaient ceux du CDC d'Atlanta et la réalisation d'une goutte épaisse dans notre contexte. Une surveillance des plaies opératoires a été faite jusqu'au 30ème jour post-opératoire. RÉSULTATS: Nous avons enregistrés 200 patientes dont 138 opérées et 62 non opérées parmi lesquelles 30 patientes ont développé une infection associée aux soins soit un taux de 15%. L'âge moyen des patientes ayant présenté une infection a été 32,52 ans ±13,36 ans contre 29.36 ans ±10,28 ans pour les patientes n'ayant pas présenté l'infection. Sept virgule cinq pourcent des patientes évacuées ont présenté une infection associée aux soins. Les types d'infections les plus retrouvés étaient l'infection du site opératoire avec 56,60% suivie du paludisme avec 23,30% et l'infection urinaire avec 20,00%. L'Escherichia coli et l'Acinetobacterbaumanii ont été les germes les plus retrouvés. Les germes isolés étaient dans 100% des cas résistants à l'Amoxicilline, dans 88,88% des cas résistants à la Ciprofloxacine et dans 77.77% des cas résistants à l'Amoxicilline +Acide clavulanique. La durée moyenne d'hospitalisation des patientes ayant développé l'infection a été 14,70 jours avec des extrêmes de 5 et 46 jours.Le taux de mortalité a été de 1,50%. Le coût moyen de prise en charge des patientes ayant développé l'infection a été 119837 FCFA ; les extrêmes ont été 17750 et 825750 FCFA et l'écart type de 174998 francs CFA. CONCLUSION: les infections associées aux soins restent fréquentes dans notre service et dominées par les infections du site opératoire. Les germes isolés étaient tous résistants dans 100% cas à l'Amoxicilline dans 88,88% cas à la Ciprofloxacine.

[Rhegmatogenous retinal detachment: Topography of breaks and agreement with lincoff's rules]. / Décollement de rétine rhegmatogène : topographie des déhiscences et conformité aux lois de Lincoff.

PURPOSE: To study the topography of retinal breaks and their agreement with Lincoff's rules. MATERIALS AND METHODS: We performed a retrospective descriptive study of patients with recent rhegmatogenous retinal detachments followed on the ophthalmology service of Abass Ndao Hospital from January 2006 through December 2016. Patients with no prior retinal treatment were included. RESULTS: Over 11 years, we reviewed 97 patients with 107 eyes with retinal detachments. The mean age of our patients was 51.7 years, range 23-79 years. There were 69 male patients, for a male:female ratio of 2.46. Refraction revealed that 38.1% of patients were myopes. Fourteen percent (14%) of patients had experienced trauma to the eye with the detachment. The right eye was involved in 54.6% of patients. The onset was insidious in 54.6% of cases and sudden in 23.7% of cases. All patients had decreased visual acuity, associated with a scotoma in 26.8% of cases. Visual acuity was decreased to light perception through 7/10. In 64.9% of cases, Lincoff's rules were observed. DISCUSSION: Lincoff's rules are still relevant for localization of the breaks in retinal detachments. CONCLUSION: Diagnosis of a retinal detachment is an essential step, since it determines the treatment. Lincoff's rules still have a role in finding the retinal break in retinal detachments.

[Role of CT in diagnosis and monitoring of retinoblastoma in Senegal]. / Apport de la TDM dans le diagnostic et le suivi du retinoblastome au Sénégal.

INTRODUCTION: Retinoblastoma is a malignant tumor of neuroepithelial origin, developed from young retinal cells, occurring in infants and young children. The goal of the study was to assess the role of CT in the diagnosis of retinoblastoma at the Aristide le Dantec Hospital in Dakar. PATIENTS AND METHODS: This is an 11-year retrospective study of 160 patient records in the ophthalmology department and pediatric oncology unit of the same hospital. RESULTS: One hundred and sixty (160) patients were recruited. The male:female ratio was 1.05. The mean age was 32.19 months. Leukocoria was the most common clinical sign, occurring in 105 cases (65.62 %). The retinoblastoma was intraocular in 97 cases (60.62 %). We saw 122 (76.25 %) unilateral and 3 (1.87 %) trilateral presentations. CT was performed in 150 children with 110 cases (73.33 %) of calcifications ; 62 cases (41.33 %) of optic nerve invasion ; 24 cases (16 %) of extraocular muscle invasion and 18 cases (12 %) endocranial extension. Associated tumors were found on CT: 2 cases of suprasellar mass and 1 case of pineoblastoma. In patients whose specimens were analyzed, histology showed 48.15 % optic nerve invasion, consistent with the CT findings. DISCUSSION: CT has an important role in the diagnosis of retinoblastoma, despite its recent contraindication in bilateral and unilateral multinodular forms. CONCLUSION: CT is a good alternative to MRI in the diagnosis of retinoblastoma in developing countries with limited technological resources.

[Ametropia among senegalese children in a hospital setting]. / Amétropie de l'enfant sénégalais en milieu hospitalier.

INTRODUCTION: Ametropia is common in children and cause strabismus and amblyopia. The goal was to establish its prevalence in a hospital setting among Senegalese children. PATIENTS AND METHODS: This was a retrospective study of patients under 15 years of age with clear ocular media. The marital status, circumstances of discovery, and results of cycloplegic refraction were recorded. RESULTS: Of 1506 children, 175 demonstrated ametropia. The mean age was 8 years, and the male : female ratio was 0.68. Family history of ametropia was present in 8.5 %. Decreased VA was present in 39.66 %, headache 10.06 %, and strabismus 4.47 %. Automated refraction in 109 patients and skiascopy in one patient showed 58.18 % cases of myopia, 18.18 % of hyperopia and 36.57 % of astigmatism. DISCUSSION: The most common ametropia was myopia. Patients were referred for symptomatic ametropia. CONCLUSION: Screening for ametropia might occur earlier if it is associated with pediatric monitoring in our regions.

[Giant retinal tears: Senegalese experience]. / Aspect thérapeutique des déchirures géantes de la rétine : expérience sénégalaise.

PURPOSE: To appreciate the epidemiological characteristics and to show the therapeutic aspects of the giant retinal tears. PATIENTS AND METHODS: We conducted a retrospective study from January 2014 to June 2017 on subjects with giant retinal tears. Patients with media opacities limiting examination were excluded. RESULTS: We identified 17 cases of giant retinal tears. The frequency of detachments related to a giant retinal tear was 17% compared to all retinal tears. The mean age was 50.75 years with a sex ratio (M/F) of 6.5. We found three cases of high myopia, one case of hyperopia and four trauma cases. All patients had a decrease in visual acuity. The average time to consultation was four weeks. The mean intraocular pressure was 8mmHg. The tear was found in the left eye in eight cases and in the right eye in five cases; two cases were bilateral. We performed intraocular surgery in five eyes and laser in four eyes. We achieved anatomical reattachment and functional improvement in all operated patients. COMMENTS AND CONCLUSION: The prognosis of a giant retinal tear remains guarded, especially if patients are seen and treated late. Laser photocoagulation of giant tears remains effective, especially in cases of early diagnosis.

[Evaluation of mean macular thickness by optical coherence tomography (SD OCT) in black Senegalese subjects]. / Évaluation de l'épaisseur maculaire moyenne par la tomographie en cohérence optique (SD OCT) chez le sujet mélanoderme sénégalais.

INTRODUCTION: Our goal was to evaluate the normal macular thickness in Blacks by OCT and to determine socio-demographic and clinical parameters which may influence it. MATERIALS AND METHODS: This was a multicenter, prospective, descriptive study over 6 months. It included Black adults followed in the ophthalmology departments of Abass Ndao and Aristide-Le-Dantec hospitals in Dakar. Included subjects had corrected visual acuity of 10/10 (0 logMAR) and P2 (+0.1 logMAR), clear ocular media, and no retinal abnormalities. We used the Topcon 3D 2000 OCT to measure the central thicknesses of the cornea (CT) and of the macula (MT), and cup to disc ratio (C/D) in each eye. Socio-demographic, clinical and tomographic data were collected on a survey form and correlated to the MT. The analysis was carried out by the Epi info 7 software. We used the Chi2 comparison test with a P value˂0.05. RESULTS: One hundred and nine patients were included. The mean age was 27.39 years with a male/female ratio of 0.65. The subjects were emmetropic in 54.13% of cases. The mean CT was 519.97µm, the mean C/D was 0.23, and the mean MT was 264.35µm. The P-value (P) was greater than or equal to 0.1 for all the factors studied. CONCLUSION: MT in our study was lower than that of Whites, and the various parameters studied did not demonstrate a statistically significant influence on MT.

[Perception of ocular blinding manifestations of sickle cell disease by practitioners in Dakar university hospital]. / Perception des lésions oculaires cécitantes de la drépanocytose par les praticiens hospitalo-universitaire de Dakar.

INTRODUCTION: In Senegal, 10% of the population are said to be carriers of hemoglobin S, the most widespread hemoglobinopathy in the world. It is responsible for potentially blinding ophthalmological manifestations. Few practitioners refer patients for ophthalmologic screening. The goal of our study was to assess the level of knowledge of practitioners of the blinding ocular lesions of sickle cell disease. MATERIALS AND METHODS: A cross-sectional prospective study was carried out over five months. It included Dakar university hospital practitioners aside from ophthalmologists. On the survey form, each practitioner specified his or her specialty and responded to eight questions regarding sickle cell patients seen in consultation, knowledge of the blinding lesions related to the disease, and ocular monitoring for blinding systemic diseases. The practitioners were divided into three groups: department of medicine and medical specialties (group I), surgery and surgical specialties (group II), and biology and functional testing (group III). The descriptive analysis was done with the EPI-INFO software version 6.04. RESULTS: The participation rate was 45.88%. Group I represented 45.29% of the sample, Group II 35.85% and Group III 18.86%. In all, 87.73% of practitioners saw sickle cell patients in consultation, 75.47% were aware of ocular involvement related to sickle cell disease, and 58.49% were aware of blinding lesions. 94.62% of practitioners saw sickle cell disease patients without systematically recommending ophthalmological consultation. CONCLUSION: Practitioners' level of knowledge of the blinding ocular lesions of sickle cell disease is considered to be low.

[Patients' quality of life after cataract surgery]. / Qualité de vie des patients après chirurgie de la cataracte.

INTRODUCTION: Our goal is to assess the Quality of Life (QL) of our patients after cataract surgery. MATERIALS AND METHODS: We performed a multicenter prospective study from July 2012 to December 2013 including patients undergoing cataract surgery, aged 18 and older. A survey sheet with sociodemographic data, clinical data and QL survey (VF-14) was given to each patient after surgery at day 7 (D7), one month (M1) and two months (M2) postoperatively. The final score was obtained by the following formula: QL=V (%)=(F __/__ C)×25. The data analysis was performed using SPSS software. RESULTS: A total of 100 patients were included, 56 men, and 61 years was the mean age. The mean QL score was 29.86% at D7, 73.97% at M1 and 81.21% at M2. Subjects between 18 and 30 years of age had a score of 90.15% vs. 82.52% at M2 for older patients. After optical correction, the quality of life scores increased from 83.22% at D7 to 93.18% at M2. Patients who did not have functional signs had a QL score of 83.94%. Anxious patients had a QL score of 44% at D7, 61.23% at M1 and 52.67% at M2. CONCLUSION: Good surgical outcomes require, in addition to clinical success, good quality of life. Several factors may influence this quality of life.

[Rare causes of childhood leukocoria]. / Les causes rares de leucocorie chez l'enfant.

PURPOSE: The purpose was to record the causes of leukocoria among children under 10years of age and to determine the proportion of rare causes of leukocoria. PATIENTS AND METHODS: This retrospective study was conducted over a period of ten years, from January 1, 2004 to December 31, 2013, in patients under 10years of age who were referred for leukocoria. RESULTS: Leukocoria represented one of the ten reasons for consultation among children under 10years of age. The mean age of our patients was 42.5months. In 76 % of cases, the leukocoria patients were children under 6years of age. Male patients were affected more commonly, with a sex-ratio of 1.5. Patients coming from Dakar and its suburbs represented two thirds of the total. Bilateral involvement represented 53.7 % of the total. Cataracts were responsible for 74.3 % of cases, retinoblastoma 20.58 %, retinal detachment 0.96 %, retinopathy of prematurity 0.96 %, pupillary membrane persistence 0.96 %, persistent hyperplastic primary vitreous 0.64 %, endophthalmitis 0.64 %, optic nerve coloboma 0.32 %, iris heterochromia 0.32 % and ametropia 0.32 %. DISCUSSION: The total percentage of rare causes was 5.12 % in our study, including one case of hyperopia. These etiologies, although rare, do exist. CONCLUSION: Rare causes of leukocoria require special attention. The discovery of leukocoria necessitates rigorous etiological work-up. Ametropia must be a diagnosis of exclusion.

[Isolated microspherophakia in a Senegalese family]. / Microsphérophakie isolée dans une famille sénégalaise.

PURPOSE: To report the clinical investigation of isolated microspherophakia involving a Senegalese family in order to appreciate its functional impact. OBSERVATIONS: This is a rural family comprised of 7 members. The sibship included three girls and two boys. One of the girls, who lived in a distant zone, was unable to be examined. Of all the examined members of the family, only the father was unaffected by the illness. There was no consanguinity. The general medical examination was normal. The best-corrected visual acuity (VA) for the girls was 2/10. For one of the boys, BCVA was 8/10 for both eyes, and for the other, BCVA was 10/10 for the right eye and 8/10 for the left eye. The mother's VA was 10/10 and P2 without correction. Myopia and astigmatism were present in the 4 children of the sibship. During the examination, we noted the presence of small crystalline lenses, which were very round and presented an abnormal visibility of the lens equator and zonular fibers. The diagnosis of microspherophakia was confirmed by measurement of the lens diameters by ultrasound biomicroscopy. Complications were present in the girls, including pupillary block glaucoma and amblyopia for the elder, and retinal degeneration and amblyopia for the younger daughter. The elder daughter was managed medically with glaucoma drops. The younger daughter received optical correction and a prophylactic Argon LASER treatment. The two boys received optical correction. No treatment was recommended for the mother. CONCLUSION: Microspherophakia is a rare condition. Some serious complications can lead to amblyopia. A better multidisciplinary evaluation would allow for early detection and a better prognosis.

Indifférence congénitale à la douleur chez un garçon de 27 mois

Introduction : Nous rapportons le cas d'une indifférence congénitale à la douleur encore appelée analgésie congénitale ou algo-ataraxie, découverte chez un garçon de 27 mois. Observation : Le patient était né à terme, complètement vacciné avec un développement psychomoteur correct, en phase sensori-motrice et prospective. La mère avait rapporté une absence de pleurs ou de changement de comportement lors des vaccinations. Elle avait aussi rapporté des morsures répétées de la langue et des faces muqueuses des lèvres. Il n'y avait pas d'antécédents familiaux particuliers déclarés. Le diagnostic a été évoqué devant les brûlures répétées des mains associées à des lésions d'automutilation. Il y avait de multiples stigmates d'anciens traumatismes à la tête, au tronc et aux quatre membres. L'examen clinique avait objectivé une indifférence à la douleur et à la chaleur. L'électromyogramme avait mis en évidence une polyneuropathie sensitive des quatre membres.Conclusion : L'indifférence congénitale à la douleur chez un garçon issu d'un milieu défavorisé, en pleine phase sensori-motrice et prospective du développement psychomoteur, pose le problème de sa mise en danger permanente. La prise en charge pluri-disciplinaire et l'éducation parentale doivent préserver l'intégrité physique et assurer un développement psychomoteur correct

[Ocular lesions of artificial depigmentation]. / Lésions oculaires de la dépigmentation artificielle.

PURPOSE: To evaluate the type and frequency of the ocular lesions found in patients practicing artificial depigmentation. PATIENTS AND METHOD: We conducted a prospective study over 3 months involving 108 patients, of whom 72 underwent depigmentation, and 36 did not, representing the controls. RESULTS: Among patients undergoing depigmentation, 100% were female, of whom 34.72% developed ocular lesions. Exogenous ochronosis lesions of the eyelid predominated (34.72%), followed by ocular ochronosis (25.81%). Cataract (19.35%) and glaucoma (6.45%) were the least frequent. Among the untreated, only 19.44% had ocular lesions. These included cataract (57.14%) and glaucoma (42.86%). Ocular lesions were more frequent in patients using products containing hydroquinone. CONCLUSION: Artificial depigmentation is responsible for ocular lesions of variable severity. Our study highlights the importance of the raising awareness amongst the general population of the complications of artificial depigmentation, particularly the ocular lesions.

[Objective refraction in black children: cyclopentolate and tropicamide combination, a reliable alternative to atropine?]. / Réfraction objective chez l'enfant mélanoderme: l'association cyclopentolate et tropicamide, une alternative fiable à l'atropine ?

INTRODUCTION: Cycloplegia allows for an objective refraction in children. Atropine is the gold standard but causes prolonged blurred vision. Cyclopentolate is less effective but less disabling. Tropicamide is a weak cycloplegic. The purpose of this study was to evaluate a cyclopentolate and tropicamide combination (CTA) versus atropine for refraction in black children. MATERIALS AND METHODS: We performed a prospective study between October 2011 and July 2012 on all children seen in consultation. Objective refraction was performed after cycloplegia with cyclopentolate 0.5% combined with tropicamide 0.5%, and then after cycloplegia with atropine. RESULTS: Thirty-three patients were recruited, 14 boys and 19 girls. The average age was 9.9 years. The mean age of the patients was 9.9 years. Astigmatism was found in 96.9% of cases. It was 1.34±1.32 diopters with CTA and 1.35±1.22 diopters with atropine. The mean axis was 98.15 and 99.8, respectively. Hyperopia and myopia were found in 39 and 27 eyes, respectively with ACT (average 1.73 and 5.37 diopters), and in 41 and 19 eyes with atropine (average 2.06 and 6.11 diopters). DISCUSSION: There is a good correlation of results with regards to cylindrical and spherical refractive error between the two protocols. Atropine is the best cycloplegic, however ACT provides reliable results. CONCLUSION: The cyclopentolate-tropicamide combination is satisfactory for routine cycloplegia in children.

[Central corneal thickness in Senegalese melanoderms with primary open angle glaucoma]. / Épaisseur cornéenne centrale chez le mélanoderme sénégalais atteint de glaucome primitif à angle ouvert.

PURPOSE: To measure the central corneal thickness (CCT) in Senegalese melanoderms with primary open angle glaucoma (POAG) and to determine its effect on visual impairment, intraocular pressure, optic nerve and perimetric damage. PATIENTS AND METHODS: We studied retrospectively the records of patients followed for POAG between May and July 2012. We recorded CCT measured by ultrasonic pachymetry and results of the first clinical examinations, including best-corrected visual acuity (CVA), intraocular pressure (IOP) by Goldmann tonometry, cup-to-disc ratio (C/D), and visual fields by automated perimetry according to the classification of Hodapp. RESULTS: Two hundred and thirty-four eyes of 117 patients were enrolled. Mean age was 56.53 ± 11.29 years and gender ratio was 2.77. Mean CCT was 525.40 ± 39.63 µm for all eyes, right and left (P=0.734). Women had a mean CCT of 521.20 ± 36.20 µm and men 526.91 ± 40.79 µm (P=0.332). Corneas were thinner in patients over 50 years (P=0.0047), in eyes having a CVA<3/10 (P=0.01) or a C/D ≥ 0.8 (P=0.043). CCT had no correlation with frequency of ocular hypertension (P=0.16) or advanced visual field defect (P=0.33). CONCLUSION: CCT of glaucomatous Senegalese is independent of laterality and sex, but decreased with age. A thin cornea is a risk for visual loss and optic cup enlargement, thus the importance of systematic measurement of CCT.

[Sensitivity to antibiotics and genetic support to resistance of Shigella flexneri strains isolated in Dakar from 2001 to 2010]. / Sensibilité aux antibiotiques et supports génétiques de la résistance des souches de Shigella flexneri isolées à Dakar de 2001 à 2010.

Diarrheal diseases remain a leading cause of death with 14.7 million deaths in 2001 and 26% of global mortality worldwide according to WHO. Shigella species are prevalent in tropical areas; they are present all the year, with epidemic outbreaks in rainy season. Between 2001 and 2010 one hundred ninety (190) strains of Shigella flexneri isolated from National Senegalese Enterobacteriaceae Center located at the Pasteur Institute in Dakar were studied. Susceptibility was performed by antibiogram following the CASFM recommendations. Detection and characterization of integrons and resistance genes was done by PCR using specific primers and sequencing. Antibiotic susceptibility showed high percentage resistance to tetracycline: 95%, cotrimoxazole 60%, ampicillin 55%. Nineteen strains were cephalosporin resistant (10%). Two isolates were resistant to quinolones and one was imipenem resistant. Genes tet, dfr, cat, bla tem1 , bla oxa30 , bla shv , bla CTX-M , blakpc,bla IMP , gyrA, gyrB, parC and parE were detected on isolates. Integrons harbored genes resistance. The class 1 integron predominated followed by class 2 integron. Genes bla oxa30 , aadA1/aadA2 dfrA1, dfrA7 were found on class 1 integron. Class 2 integron showed three different types cassettes. No class 3 integron was detected. Genes dfrA1, dfrA7, sat, and aadA1 were harbouring by integrons. Antibiotic susceptibility showed that Shigella flexneri strains are resistant to the first line drugs used to treat shigellosis in Senegal. Resistance to 3rd generation of cephalosporins and fluoroquinolones emerged and is of great concern. These molecules must be used with caution in the treatment of shigellosis.

[Ocular lesions in melanodermia patients with chronic renal failure]. / Les lesions oculaires chez le patient melanoderme atteint d'insuffisance renale chronique.

AIM: To describe the and the factors that influence their occurrence. MATERIAL AND METHODS: A prospective study was performed over a year in the Ophthalmology clinic of Aristide le DANTEC Hospital, including 112 eyes of chronic renal failure patients followed up in the internal medicine unit of the same hospital. For each patient data of his follow up in the nephrology ward were recorded, even as the ophthalmological clinical examination which included colour test and angiography. All the lesions found were recorded on a questionnaire, seeking for any influence as far as age, sex, duration of signs, dialysis, and general complications were concerned. The analysis was performed using the 2005 Epi-info 6.0 software. RESULTS: Sex ratio was 1.54. 70% were above 40 years old. Blindness was found on 44.6% of the eyes. There were 20.5% cases of eye lids oedema, 15.8% conjunctival calcifications, 26.8% cataracts, 3 cases of ocular hypertension, 7.1% corneal lesions. Hypertensive retinopathy was found on 75.9% of the cases, amongst 14.3% classified stage 3, and retinal oedema signs associated on 13.8%, arteriosclerosis on 14.3% of the cases. 88.1% had confirmed signs of dyschromatopsia. On angiography, there was evidence of chorioretinal lesions due to high blood pressure, including decrease of the choroidal blood flow, choroidal ischemic areas, and halo peripapillary oedema. Age was a risk factor for eye lid oedema. Corneal and conjunctival lesions, even as eye lid oedema and hypertensive retinopathy were more frequent on patients, sick for less than a year. High blood pressure was a risk factor for papillary lesions, hypertensive retinopathy, and dyschromatopsia. Corneal and conjunctival calcifications were found mostly on patients on dialysis, whereas they had less eye lid oedema, hypertensive retinopathy, and maculopathy. CONCLUSION: Retinal lesion, especially due to high blood pressure is the most described. It permits to establish the prognostic of the disease. Patients on dialysis show a decrease of that retinopathy, but some sequels might persist which are invalidating, irreversible and may lead to blindness. This can be prevented by early screening of high blood pressure and an adequate treatment of chronic renal failure. Ophthalmologic examination remains a cheap and simple method to prevent the complications.

Les lesions oculaires chez le patient melanoderme atteint d'insuffisance renale chronique

But : Decrire les signes oculaires rencontres au cours de l'insuffisance renale chronique (IRC) chez le melanoderme senegalais et les facteurs influents leur survenue. Materiel et methodes : Nous avons realise a la clinique ophtalmologique de l'Hopital A. le Dantec; une etude prospective sur un an. Elle portait sur 112 yeux de patients atteints d'IRC et suivis a la clinique medicale du meme hopital. Pour chaque patient; nous avons releve les donnes de son suivi en nephrologie; de l'examen clinique ophtalmologique; du test des couleurs et de angiographie. Les lesions constatees ont ete correlees a l'age; au sexe; a la duree d'evolution des signes; a l'hypertension arterielle (HTA); au taux d'hemoglobine; au recours a la dialyse dans le traitement; a la presence de complications generales. Cette analyse a ete effectuee avec logiciel epi info 6.0 version 2005. Resultats : le sex ratio etait de 1;54 et 70avait plus de 40 ans. 44;6des yeux presentaient une cecite. On comptait 20;5d'oedemes palpebraux; 15;8de calcifications conjonctivales; 26;8de cataractes; 3 cas d'hypertonies oculaires; 7;1de lesions corneennes. La retinopathie hypertensive s'observait dans 75;9des cas; dont 14;3au stade 3. Elle s'accompagnait d'oedeme retinien dans 13;8des cas et d'arteriosclerose dans 14;3des cas. Les dyschromatopsies etaient objectivees dans 88;1des cas. L'angiographie objectivait des atteintes chorio-retiniennes de l'HTA; une reduction de la perfusion choroidienne; des zones d'ischemie choroidienne; des atrophies peripapillaires aureolaires. L'age exposait a l'oedeme palpebral. Les lesions corneoconjonctivales; l'oedeme palpebral et la retinopathie hypertensive etaient plus frequents chez ceux qui evoluaient depuis moins d'un an. L'HTA exposait aux lesions papillaires; a la retinopathie hypertensive et aux dyschromatopsies. Ceux qui beneficiaient de la dialyse presentaient plus de calcifications corneoconjonctivales et moins d'oedeme palpebral; de retinopathie hypertensive; de maculopathie. Conclusion: L'atteinte retinienne surtout celle liee a l'HTA; est la lesion la plus decrite. Elle permet d'etablir le pronostic de l'affection. Elle regresse chez les patients soumis a la dialyse. Cependant; elle peut laisser des sequelles invalidantes; irreversibles et cecitantes. Sa prevention passerait par un depistage precoce de l'HTA et une prise en charge adequate de l'IRC. L'examen ophtalmologique reste une methode simple et peu onereuse pour prevenir les complications

[Local anesthesia in children's ocular surgery]. / Anesthésie loco-régionale dans la chirurgie oculaire de l'enfant.

PURPOSE: Present a Senegalese experience of local anesthesia in children's ocular surgery. PATIENTS AND METHODS: We conducted a retrospective study on 309 patients under 15 years of age, operated on in our department from June 1998 to December 2002. The type of anesthesia, general or local, was noted. The latter consisted in a retrobulbar and/or a peribulbar injection, with 4 ml of 50% of lidocaine 2% and bupivacaine mixture. RESULTS: Local anesthesia was given to 38.8% of patients, who had a mean age of 11.51 years, with a sex ratio of 2.4. The mean age of patients operated on with general anesthesia was 4.6 years. No complications were noted in the local anesthesia group. One operation was postponed because of lack of cooperation. In this group of operated patients, 62.5% had a cataract surgery, 16.7% a corneal laceration suture, and 10.0% mutilating surgery. COMMENTS: Because of our working conditions, local anesthesia, more than a choice, is almost obligatory. Our study shows that local anesthesia in children's ocular surgery has many advantages and few disadvantages. However, this study is limited because of a lack of information on the anesthesia and postoperative reactions. A prospective study based on a questionnaire completed by the anesthesiologist and the surgeon at the end of surgery will be necessary. CONCLUSION: Ocular surgery under local anesthesia is possible in children as young as 10 years of age. Good psychological preparation of the patient and the presence of the parents, from the consulting room to operating room, are required.