LES FRACTURES DE L’OS ZYGOMATIQUE AU CHU SYLVANUS OLYMPIO DE LOME : A PROPOS DE 152 CAS.

Background: fractures of the zygomatic complex are a fairly common phenomenon in the practice of maxillo-facial traumatology and are a major problem or therapeutic management due to possible functional and aesthetic complications. The purpose of this study was to report the different epidemiological, clinical and therapeutic aspects of fractured zygoma in Lomé. Methods: A 10-year retrospective audit was undertaken of all hospitalized patients, at the department of ENT and Cervico-maxillofacial surgery in Sylvanus Olympio teaching Hospital of Lomé (Togo), who had sustained a fractured zygoma from 2004 to 2013. Results: A total of 152 fractures were sustained and representing 5.4% of all the patients of the department. The average age of the patient was 34 years. The sex distribution is markedly higher for males than for females (6.6/1). Road traffic accidents (88.8%) were the main etiology and motorcycle accident (42.76%) were predominant. Tetrapod fractures (61.18%) were the most frequent type of fractures. In 16,44% of cases fracture of zygoma were not associated with another fracture. Cases were managed by either closed (50%) or open (48.90%) reduction. Percutaneous reduction described by Ginestet (60.43%) was the commonest technique employed for closed treatment and transosseous wiring (66.29%) was the most frequently employed fixation for open reduction Conclusion: fractures of the zygomatic bone are relatively frequent interesting young and male people, due to traffic accidents. Road safety must be respected and the open reduction treatment increasd

Cancers Primitifs Oto-Rhino-Laryngologiques Et Cervico-Maxillo-Faciaux De L’enfant: Aspects Épidémiologiques Et Histopathologiques

Objective: Have a view on child’s head and neck cancers in a reference centre in Togo. Methodology: It was a descriptive retrospective study about the cancers diagnosed among children under 15 years in head and neck department of Sylvanus Olympio Teaching Hospital of Lomé in Togo from 1st January 2005 to 31 December 2014. The pieces were analysed in the pathological anatomy laboratory of the same teaching Hospital. Results: The child’s head and neck cancers represented 0.8 % of the whole ENT tumours and 5.5% of head and neck cancers. The average age was 8 years ± 4.7 ranging from 3 months to 15 years. The male sexe was predominant in 15 cases. The frequent location was ganglions, followed by oral cavity (gingivo-maxillary location and gingivo-mandibular location) in respectively 13 and 6 cases. The sinus, rhinopharynx, and larynx locations were found in 01 case of each cancer. In terms of histopathology, there were 21 cases of non-Hodgkin’s lymphoma of which 09 cases of Burkitt’s and 01 case of inferior lip neuroblastoma. Conclusion: Child’s head and neck cancers are scarce in Togo and dominated by malignant primitive cervical adenopathy

MERIT, a cellular system coordinating lysosomal repair, removal and replacement

Membrane integrity is essential for cellular survival and function. The spectrum of mechanisms protecting cellular and intracellular membranes is not fully known. Our recent work has uncovered a cellular system termed MERIT for lysosomal membrane repair, removal and replacement. Specifically, lysosomal membrane damage induces, in succession, ESCRT-dependent membrane repair, macroautophagy/autophagy-dominant removal of damaged lysosomes, and initiation of lysosomal biogenesis via transcriptional programs. The MERIT system is governed by galectins, a family of cytosolically synthesized lectins recognizing β-galactoside glycans. We found in this study that LGALS3 (galectin 3) detects membrane damage by detecting exposed lumenal glycosyl groups, recruits and organizes ESCRT components PDCD6IP/ALIX, CHMP4A, and CHMPB at damaged sites on the lysosomes, and facilitates ESCRT-driven repair of lysosomal membrane. At later stages, LGALS3 cooperates with TRIM16, an autophagy receptor-regulator, to engage autophagy machinery in removal of excessively damaged lysosomes. In the absence of LGALS3, repair and autophagy are less efficient, whereas TFEB nuclear translocation increases to compensate lysosomal deficiency via de novo lysosomal biogenesis. The MERIT system protects endomembrane integrity against a broad spectrum of agents damaging the endolysosomal network including lysosomotropic drugs, Mycobacterium tuberculosis, or neurotoxic MAPT/tau. Abbreviations: AMPK: AMP-activated protein kinase; APEX2: engineered ascorbate peroxidase 2; ATG13: autophagy related 13; ATG16L1: autophagy related 16 like 1; BMMs: bone marrow-derived macrophages; ESCRT: endosomal sorting complexes required for transport; GPN: glycyl-L-phenylalanine 2-naphthylamide; LLOMe: L-leucyl-L-leucine methyl ester; MAP1LC3/LC3: microtubule associated protein 1 light chain 3; MERIT: membrane repair, removal and replacement; MTOR: mechanistic target of rapamycin kinase; TFEB: transcription factor EB; TFRC: transferrin receptor; TRIM16: tripartite motif-containing 16

Galectin-3 Coordinates a Cellular System for Lysosomal Repair and Removal

Jia et al. show that Galectin-3 recruits ESCRT components to damaged lysosomes for repair and restoration of their function. During sustained lysosomal injury, galectins induce autophagy and lysosomal biogenesis for a staged repair, removal, and replacement program. This response is deployed during damage with neurotoxic tau or Mycobacterium tuberculosis infection

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Concours d’internat des Hôpitaux de Lomé de 1974 à 2006 : etat des lieux

Objectif: Faire l’état des lieux du concours d’internat des hôpitaux de LoméMéthodologie: Etude transversale descriptive réalisée à la faculté des sciences de la santé de l'université de Lomé et dans les centres hospitaliers universitaires de Lomé. Elle a consisté au dépouillement des documents et des archives du concours d’internat des hôpitaux de Lomé et en des entretiens semi-directs avec un échantillon d’individus ayant un rapport avec l’internat des hôpitaux de LoméRésultats: Vingt-quatre sessions ont été organisées en 33 ans. Le concours était ouvert aux étudiants ayant validé la 5è année d’études médicales. 425 candidatures ont été enregistrées : 0,08% de filles, 51,29% d’étudiants de 6ème année et 15,33% d’étudiants militaires. Au total 135 internes ont été nommés au cours des 24 sessions organisées (87,41% de sexe masculin). Les étudiants de sixième année (54,81%) et les civils (77,78%) étaient les plus représentés. La spécialisation des internes s’est faite au Togo dans la majorité des cas mais aussi dans certains pays africains (Sénégal, Côte d’Ivoire, Bénin). Les internes se spécialisaient plus en chirurgie (33,6%) et en gynéco-obstétrique (19,2%). Vingt-six anciens internes des hôpitaux ont opté pour la carrière universitaire. Une forte émigration des anciens internes a été notée : 80% se trouvaient en France.Conclusion: L’internat des hôpitaux de Lomé mérite des réformes prenant en compte les progrès de la Médecine, les besoins réels de l’exercice sur le terrain, et l’avenir à réserver aux lauréatsMots clés: Internat des hôpitaux- LoméEnglish Title: Lome Hospital internship competition from 1974 to 2006: the situation todayEnglish AbstractObjective: To review the state of the hospital internship competition in LoméMethodology: Descriptive cross-sectional study conducted at the Faculty of Health Sciences of the University of Lome and in the teaching hospitals of Lome. It consisted of counting the documents and archives of the hospital internship competition of Lomé and also semi-direct interviews with a sample of individuals related to the Lome hospital internship.Results: Twenty-four sessions were organized in 33 years. The competition was open to students who have validated the 5th year of medical studies. 425 applications were registered: 0.08% of girls, 51.29% of 6th year students and 15.33% of military students.  A total of 135 interns were appointed during the 24 sessions organized (87.41% boys). Sixth year students (54.81%) and civilians (77.78%) were the most represented. The specialization of interns was done in Togo in the majority of cases but also in some African countries (Senegal, Ivory Coast, Benin). The interns specialized more in surgery (33.6%) and obstetrics and gynecology (19.2%). Twenty-six former hospital interns opted for the university career. A strong emigration of former interns was noted: 80% were in France.Conclusion: Lome hospital internship deserves reforms taking into account the progress of Medicine, the actual needs of the field exercise, and the future to be reserved for the laureatesKeywords: Hospitals internship, Lom

Tuberculose orale secondaire: a propos d’un cas a Lome

La tuberculose de la cavité buccale reste rare, son tableau clinique non spécifique. L’étude bactériologique et histopathologique tient un rôle important, permettant de préciser la nature tuberculeuse des lésions. L’évolution est favorable sous traitement médical, maintenant bien codifié. Un homme de 67 ans, alcoolo-tabagique connu a consulté dans le service de stomatologie pour une ulcération linguale ; une biopsie a été réalisée et l’examen histopathologique orienté vers une tuberculose. La recherche d’autres localisations a permis de retrouver une tuberculose pulmonaire, concluant ainsi à une tuberculose bifocale. L’intérêt de cette présentation est d’attirer l’attention sur la tuberculose que l’on peut retrouver de façon exceptionnelle dans certaines localisations, comme la cavité buccale.Mots-clés: tuberculose orale ; nécrose caséeuse ; tuberculose pulmonaireEnglish Title: Secondary orale tuberculosis: about one case at LomeEnglish AbstractTuberculosis of the oral cavity remains rare, and clinically non-specific. Bacteriology and histopathology are important to confirm the diagnostic of tuberculosis of the oral lesion. The evolution is favourable with medical treatment, now well codified. A 67-year-old male, known alcoholic-tobacco was received in stomatology department for lingual ulceration. A biopsy was performed and histopathologic examination has concluded to tuberculosis. The searches for other localizations find pulmonary tuberculosis, thus concluding with bifocal tuberculosis. The interest of this presentation is to draw attention to tuberculosis which can be found exceptionally in certain localizations, such as the oral cavityKeywords: oral tuberculosis; caseating; pulmonary tuberculosi

Traumatismes maxillo-faciaux avec trouble de l’articule dentaire a propos de deux observations au chu-campus de lome.

Les fractures avec trouble de l’articulé dentaire surviennent souvent au cours des traumatismes maxillo-faciaux. La topographie des lésions ainsi que leurs éventuelles complications posent un problème au sujet de leur prise en charge. Il s’agit à travers ce travail, de souligner l’importance d’un apport odontologique simultané pour une prise en charge thérapeutique plus adéquate des traumatismes maxillo-faciaux avec trouble de l’articulé dentaire. Deux observations concernant deux patients victimes de traumatisme maxillaire et traités au CHU-SO de Lomé, l’un en avril et l’autre en septembre 2004 constituent la substance de ce travail. Chacun des 2 malades avait bénéficié initialement de soins extra hospitaliers d’une durée de 10 jours pour la patiente et 8 jours pour le sujet masculin. Une béance incisive, une douleur à la palpation des apophyses ptérygoïdes ainsi que le ¨signe du dentier ¨et des lésions ORL associées étaient observés lors de l’examen clinique chez les deux patients. La prise en charge clinique des deux sujets s’est faite dans des conditions presqu’identiques, la seule différence relevée portait sur l’association pour le sujet féminin d’une prise en charge Odontologique simultanée à toutes les étapes (réduction et contention par blocage inter-maxillo-mandibulaire, soins ORL, soins médicaux et suivi).Aucune particularité n’avait été observée du point de vue odontologique à la prise en charge du sujet masculin. Une observation comparative des suites thérapeutiques nous a permis de relever dans l’évolution, une consolidation des fragments confirmée par contrôle radiographique au bout du 45ème jour dans les 2 cas. Au déblocage maxillomandibulaire, les suites thérapeutiques révélaient une malocclusion chez le sujet masculin et un meilleur résultat chez le sujet féminin. 8 ans après, certaines séquelles sur l’occlusion dentaire étaient encore ressenties et exprimées par le sujet masculin en dépit d’un traitement secondaire correctif sur l’articulé dentaire qui lui avait été administré dans les suites. Un apport odontologique simultané dès la phase initiale de la prise en charge devrait permettre d’assurer dans les suites thérapeutiques, de meilleures conditions de consolidation des fractures maxillo-faciales avec trouble de l’articulé dentaire.Mots clés : Traumatisme, maxillo-faciale, fracture, trouble de l’articulé dentaire