PLAIE ACCIDENTELLE DE L’ARTERE RADIALE LORS DE L’ABORD ANTERIEUR DE L’AVANTBRAS : INTERET DU NON USAGE DU GARROT

Authors report one case of radial artery accidental wound in a 37 years old man who has presented malunion at the one third middle of the two forearm bones during radial focal abord by Henry way. The external bord of flexor carpi radialis muscle was not easy to identify because of anatomics connections modifications by malunion itself and amyotrophy. The garrot was not used at the beginning. A longitudinal wound of about one half centimeter of radial artery occurred and was repaired by classic way. Postoperative affects were simples. The tourniquet non use permit to recognize immediately the complication and to treat it quickly

Propionibacterium acnes as a cause of shoulder osteoarthritis after three shoulder arthroscopies: a case report and review of preventive action

We report a case of postoperative osteoarthritis infection caused by P. acnes after shoulder arthroscopy, and review possible preventive action. A right-handed 24-year-old man presented an anterior instability of the left shoulder. The patient underwent an anterior stabilization by the latarjet procedure. Stabilization failed, requiring a second and third surgery. The patient returned 10 months later for suspected septic arthritis of his left shoulder. An arthroscopy lavage with bacteriological and anatomo-pathological sampling was carried out. The bacteriological results revealed a positive P. acnes culture. The patient was treated using antibiotherapy for 12 weeks with a combination of clindamicin and moxifloxacin. C-reactive protein (CRP) was negative two months after the onset of antibiotherapy.  P. acnes is a anaerobic, non-sporulated, gram-positive bacillus. This commensal germ is part of the normal cutaneous flora and causes acne, but has also been recognized as a causative pathogen in osteoarticular infections since the 1990s, as described by Coden. Treatment is achieved via surgical debridement and intravenous antibiotics. We insist on preventive action in the form of a preoperative patient preparation protocol. Previous literature has underlined the important role of chlorhexidine or alcoholic iodinated polyvidone in the prevention of these infections. As P. acnes is a commensal germ of the patient's skin, prophylaxis should be reinforced by the thorough preparation of the surgery and surgical site. Clindamycin antibioprophylaxy specific to this germ should be administered for this surgery. To my knowledge, there is no specific antibioprophylaxy for shoulder surgery to date

LES TUMEURS OSSEUSES PRIMITIVES DES MEMBRES AU CHU TOKOIN DE LOME PRIMARY BONE TUMORS OF MEMBERS IN TOKOIN TEACHING HOSPITAL OF LOME

Introduction. The purpose of this work was to analyze the epidemiological, diagnosis and therapy aspects of member’s primary bone tumors of our center to improve the management. Materials and Methods. We retrospectively analyzed the records of 32 patients treated for member’s primary bone tumors in orthopedic and trauma surgery department of Lomé Tokoin teaching hospital from January 1997 to December 2006. We collected and analyzed data on age, sex, clinical features, X-ray results, the results of the biopsy and therapeutic methods. Results. There were 13 men and 19 women. Pain was the most occasional discovery found in 84.38%. Swelling isolated or associated with pain was the second discovery circumstance in 75%. Pathological fracture showed the tumor in 12.5%. The tumor interested knee in 7 patients and leg in eight (8). Of the 21 patients (65,63%) diagnosed with benign tumors, there were 38.10% of osteogenic exostoses, 23.82% of osteoid osteoma and chondroma, the chondroblastoma, giant cell tumors then the aneurysmal cyst shared for each type 09, 52%. Osteosarcoma (5 patients; 45.46%), chondrosarcoma (3 patients; 27.27%) and Ewing's sarcoma, fibrosarcoma then angiosarcoma (1 patient; 09.90% for each histological type) were the malignant bone tumors found. Benign tumors underwent conservative surgery. All 11 patients with malignant tumors were treated by amputation. Conclusion. The primary bone tumors are relatively rare member of the Tokoin teaching hospital of Lomé. Benign tumors are more frequent. The consultation delay does not facilitate the planning of their care. The malignant tumors are treated by member amputation. It is necessary to increase public awareness about the benefit of early consultation at the slightest symptoms suggestive and advocacy with governments to equip our center which is the national reference in adequate infrastructures and resources for tumors care especially primary bone malignancies

Impact of interhospital transfer vs. direct admission on acute ischemic stroke patients: A subset analysis of the COMPLETE registry

Acute ischemic stroke; Aspiration thrombectomy; Interhospital transferIctus isquèmic agut; Trombectomia per aspiració; Trasllat interhospitalariIctus isquémico agudo; Trombectomía por aspiración; Traslado interhospitalarioBackground: Efficacy of thrombectomy treatment in acute ischemic stroke large vessel occlusion (AIS-LVO) patients is time dependent. Direct admission to thrombectomy centers (vs. interhospital transfer) may reduce time to treatment and improve outcomes. In this subset analysis of the COMPLETE registry, we compared outcomes between direct to thrombectomy center (Direct) vs. transfer from another hospital to thrombectomy center (Transfer) in AIS-LVO patients treated with aspiration thrombectomy. Methods: COMPLETE was a prospective, international registry that enrolled patients from July 2018 to October 2019, with a 90-day follow-up period that was completed in January 2020. Imaging findings and safety events were adjudicated by core lab and independent medical reviewers, respectively. Pre-defined primary endpoints included post-procedure angiographic revascularization (mTICI ≥2b), 90-day functional outcome (mRS 0–2), and 90-day all-cause mortality. Planned collections of procedural time metrics and outcomes were used in the present post-hoc analysis to compare outcomes between transfer and direct patient cohorts. Results: Of 650 patients enrolled, 343 were transfer [52.8% female; mean (SD) age, 68.2 (13.9) years], and 307 were direct [55.4% female; 68.5 (14.5) years] admit. Median onset-to-puncture time took longer in the transfer vs. direct cohort (5.65 vs. 3.18 h: 2.33 h difference, respectively; p < 0.001). There was no significant difference in successful revascularization rate, mTICI ≥2b (88.3 and 87.3%), sICH at 24 h (3.8 and 3.9%), median length of hospital stay (7 and 6 days), and 90-day mortality (16.9 and 14.0%) between transfer vs. direct patients, respectively. However, achieving 90-day functional independence was less likely in transfer compared with direct patients (mRS 0–2 was 50.3 vs. 61.7%, p = 0.0056). Conclusions: In the COMPLETE registry, direct to thrombectomy center was associated with significantly shorter onset-to-puncture times, and higher rates of good clinical outcome across different geographies. Additional research should focus on AIS-LVO detection to facilitate direct routing of patients to appropriate treatment centers.This study was funded by Penumbra, Inc (Alameda CA). OZ, JF, and AH were the study's principle investigators and were involved in study design. The sponsor was responsible for database setup, site monitoring, data management, and statistical analysis

Luxation obturatrice de la hanche: à propos d’un cas

La luxation de hanche dans sa variété obturatrice est rare. Nous rapportons un cas chez un sujet jeune de 30 ans. Le traitement orthopédique a donné de bon résultat. Le bilan radiographique à 20 mois post traumatique ne note pas de signe de nécrose aseptique de la tête fémorale.Key words: Luxation, hanche, obturatrice, Afriqu

Hématomes Extraduraux Chez L’adulte Au Togo

Purpose: The purpose of this work was to evaluate our neurosurgical practice about extradural hematoma and to describe their prognosis in our context. Patients and methods: This is a retrospective study of patients treated for extradural hematoma at Sylvanus Olympio university teaching hospital, which houses the only neurosurgery unit in Togo between April 2008 and August 2014. We included in our study, the files of patients of both sexes, aged over 15 years, with extradural hematoma isolated or not at the cerebral scanner, treated during the study period. Thus, 62 patients were taken into account. There was a male predominance (sex ratio of 19.7). The average age was 29.8 years with extremes of 02 and 70 years of which 41.9% of patients were between 20 and 29 years old. The surgical technique was the making of a burr hole or a cranial flap. We examined the parameters related to surgical treatment and the evolutionary mode. Results: In this study, 34 patients (54.8%) underwent surgery: cranial section (27 cases), widened hole craniotomy (07 cases). The average time between trauma and surgery was 09 days with extremes of 01 to 30 days. Twenty-four patients were operated more than 48 hours after diagnosis and the average postoperative follow-up time was 11.1 days with extremes of 07 and 18 days. Twenty-eight patients (45.2%) were not operated on. Among them, 20 patients presented with a HED blade (thickness of less than 10mm) and the eight (08) others for lack of financial means. The average hospital follow-up time for non-operated patients was 15.4 days with extremes of 08 and 60 days. The evolution was evaluated by the Glasgow Outcome Scale over three months. Fifty-five patients or 88.7% recovered without sequel. We obtained 3 cases (4.8%) of deaths including 2 cases that were not operated due to lack of financial means. Conclusion: We have observed that a low Glasgow admission score, long treatment delays, and associated lesions are factors that appear to reduce the prognosis in the treatment of extradural hematoma in Togo. These prognostic factors must be better documented in our future studies to identify them in order to act on them in order to reduce the morbidity and mortality that these extra-mural hematoma cause in our environments

Using Simulation-based Energy Consumption of NIU Engineering Building to Provide Cost-Saving Solutions

In the current global situation where almost all countries need energy to perform their activities, providing energy is a vital demand for modern society. Furthermore, lack of fossil energy draws attention to the utilization of renewable energy, specifically solar energy. Because no specific published record of considering renewable energy solutions applied to the buildings of Northern Illinois University (NIU) have been found already, in this paper, solar energy as an energy solution for Northern Illinois University (NIU) Engineering Building (EB) has been considered. In this case, building envelope model and HVAC system model have been developed in eQUEST software to perform simulation-based energy consumption of EB. This simulation presents annual energy consumption of boiler, chiller plant, and daylighting in EB. Moreover, economic analysis of using solar energy for lighting has been performed to identify the feasibility and savings associated with solar energy which can potentially reduce costs with a reasonable payback time

PLAIE ACCIDENTELLE DE L’ARTERE RADIALE LORS DE L’ABORD ANTERIEUR DE L’AVANTBRAS : INTERET DU NON USAGE DU GARROT

Authors report one case of radial artery accidental wound in a 37 years old man who has presented malunion at the one third middle of the two forearm bones during radial focal abord by Henry way. The external bord of flexor carpi radialis muscle was not easy to identify because of anatomics connections modifications by malunion itself and amyotrophy. The garrot was not used at the beginning. A longitudinal wound of about one half centimeter of radial artery occurred and was repaired by classic way. Postoperative affects were simples. The tourniquet non use permit to recognize immediately the complication and to treat it quickly

LES TUMEURS OSSEUSES PRIMITIVES DES MEMBRES AU CHU TOKOIN DE LOME PRIMARY BONE TUMORS OF MEMBERS IN TOKOIN TEACHING HOSPITAL OF LOME

Introduction. The purpose of this work was to analyze the epidemiological, diagnosis and therapy aspects of member’s primary bone tumors of our center to improve the management. Materials and Methods. We retrospectively analyzed the records of 32 patients treated for member’s primary bone tumors in orthopedic and trauma surgery department of Lomé Tokoin teaching hospital from January 1997 to December 2006. We collected and analyzed data on age, sex, clinical features, X-ray results, the results of the biopsy and therapeutic methods. Results. There were 13 men and 19 women. Pain was the most occasional discovery found in 84.38%. Swelling isolated or associated with pain was the second discovery circumstance in 75%. Pathological fracture showed the tumor in 12.5%. The tumor interested knee in 7 patients and leg in eight (8). Of the 21 patients (65,63%) diagnosed with benign tumors, there were 38.10% of osteogenic exostoses, 23.82% of osteoid osteoma and chondroma, the chondroblastoma, giant cell tumors then the aneurysmal cyst shared for each type 09, 52%. Osteosarcoma (5 patients; 45.46%), chondrosarcoma (3 patients; 27.27%) and Ewing's sarcoma, fibrosarcoma then angiosarcoma (1 patient; 09.90% for each histological type) were the malignant bone tumors found. Benign tumors underwent conservative surgery. All 11 patients with malignant tumors were treated by amputation. Conclusion. The primary bone tumors are relatively rare member of the Tokoin teaching hospital of Lomé. Benign tumors are more frequent. The consultation delay does not facilitate the planning of their care. The malignant tumors are treated by member amputation. It is necessary to increase public awareness about the benefit of early consultation at the slightest symptoms suggestive and advocacy with governments to equip our center which is the national reference in adequate infrastructures and resources for tumors care especially primary bone malignancies