Les fistules anastomotiques (FA) post-colectomie au Service de Chirurgie Générale de l’Hôpital Aristide Le Dantec

La fistule anastomotique reste la complication la plus redoutée après chirurgie colorectale et continue à poser un problème diagnostique et thérapeutique. Le but de cette étude est de déterminer à la fois la prévalence et les éléments de prises en charge diagnostiques et  thérapeutiques de la fistule colique après colectomie. Nous avons mené une étude rétrospective descriptive des cas de fistule colique après  colectomie sur une période de 7 ans allant de janvier 2007 au décembre 2013. Il y avait 17 patients qui ont présenté une fistule colique parmi les 170 patients ayant bénéficié de colectomie dans notre service soit un taux de 10%. L'âge moyen au moment de l'intervention initiale était de 45,1 ans (extrêmes de 20 et 78 ans). Il y avait une prédominance des patients de sexe masculin (n=13) avec un sex ratio de 3,3. Les pathologies tumorales colorectales (n=9) et le volvulus de colon pelvien (n=7) était les principales indications de colectomie L'intervention initiale a été réalisée en urgence chez 13 patients. Le délai moyen d'apparition de la fistule était de 10,8 jours. Il y avait 10 patients ayant présenté une fistule colo-cutanée et 7 cas de péritonites postopératoires stercorales. Onze de nos patients présentaient une anémie (taux moyen d'hémoglobine de 9,1 g/dl) et 8 patients, une hyperleucocytose (taux moyen de 15100  leucocytes/mm3). Une échographie, réalisée chez 6 patients, était revenue normale chez 1 patient et avait mis en évidence un épanchement intra péritonéal chez 5 patients tandis que La tomodensitométrie (TDM) sans opacification digestive, réalisée chez 2 patients, n'était contributive au diagnostic que chez 1 seul patient. Neuf patients avaient bénéficié de traitement médical seul. Ce dernier consistait en une couverture  antibiotique, un régime hyperprotéique, et un appareillage de la fistule par une poche de colostomie. La fistule s'est fermée spontanément, dans un délai moyen de 15 jours. La reprise chirurgicale a été réaliséechez 8 patients dans un délai moyen de 4,8 jours. Elle a été indiquée pour une péritonite par fistule anastomotique chez 7 patients et pour  persistance de la fistule colocutanée malgré traitement médical chez 1 patient. Le geste chirurgical consistait en une stomie digestive dans 6 cas. Sept patients ont présenté au moins une complication liée à la fistule colique (2 récidives de la fistule, 3 suppurations et 2 éviscérations). La durée moyenne d'hospitalisation était de 55,2 jours (extrêmes de 15et 168 jours). Deux décès étaient enregistrés consécutif à un choc septique. Une accessibilité des moyens thérapeutiques telles que la nutrition parentérale et le drainage percutané nous permettrait de réduire une durée d'hospitalisation prolongée et également des coûts de prise en charge élevés.Mots clés: Colectomie, anastomose, fistule, péritonite, stomi

Cervical cancer screening in pregnancy at the maternity clinics of Nabil Choucair health center and the Institute of Social Hygiene of Dakar, Senegal: a study on 67 cases

Background: This study aims were to develop the epidemiological profile of patients who received Pap smears during pregnancy, to describe aspects of cytological smears performed in pregnant women and to describe the therapeutic management in case of anomalies in the cervical smear during pregnancy.Methods: This was a prospective, descriptive and analytical study conducted from January 15, 2015 to June 31, 2015 at maternity of Nabil Choucair Health Centre and the Institute of Social Hygiene in Dakar. The Pap smear was performed in all patients who had given their consent to the experience. The parameters studied concerned socio-demographic aspects, gynecological and obstetric background, gestational age at the time of collection, cervico-vaginal smear results, diagnostic and therapeutic management of cytological and histological abnormalities. The data collected on a survey sheet prepared for this purpose were entered and analyzed through the version 3.5.3 of Epi info software.Results: During the study period, 67 pregnant women had received a Pap smear. The epidemiological profile of our patient was a paucipare gestity with an average of 3 with extremes ranging from 1 to 7, an average parity of 2.4 with extremes ranging from 1 to 7. The mean age of pregnancy was 15.4 weeks of amenorrhea (range of 6 and 32 weeks). Only 5 patients (7.4%) had already received a cervical-vaginal swab before the study. The smear was normal in 88.7% of the cases but got abnormalities in 11.3% of the cases. The abnormalities were mainly found in squamous cells and were divided into low-grade lesions (57.1%) and skew-cell abnormalities whose meaning was undetermined (42.1%). Colposcopy was performed in 8 patients. Colposcopy was normal and satisfactory in 4 patients (50%) and identified as atypical grade 1 transformation in 2 patients (25%) and an atypical grade 2 transformation in 2 patients (25%). From a therapeutic point of view, diathermic loop conduction associated with strapping was performed in one patient (12.5%) for severe dysplasia. In postpartum, all dysplastic cervical lesions diagnosed during pregnancy had declined.Conclusions: In the context of our study, where there is no organized screening policy for cervical cancer, antenatal clinics are an excellent screening opportunity to seize

Epidemiology of chronic kidney diseases in the Republic of Guinea; future dialysis needs

Background: Chronic kidney disease (CKD) is increasing worldwide and can lead to end-stage renal disease (ESRD). Objectives: Because few patients with ESRD in the Republic of Guinea have access to haemodialysis, we retrospectively evaluated the prevalence of CKD, ESRD and access to supportive therapies. Patients and Methods: 579 CKD patients (304 males; mean age: 44 ± 16 years) were admitted into Conakry nephrology department, the only centre in the Republic of Guinea, between 2009 and 2013. Most patients (63%) resided within Conakry (the capital), 12.5% came from lower Guinea, 11.7% from middle Guinea, 7.9% from upper Guinea and 4.8% from forest Guinea. Results: Reasons for referral were increased serum creatinine (49.5%), hypertension (27%) and diffuse edema (17%). Also, 11% were diabetic, 12.5% were smokers, 17% were HIV-positive, 8.3% were HBV-positive and 15% were HCV-positive. The most frequent symptom at admission was nausea/vomiting (56%). Upon admission, 70.5% of patients already had ESRD. Although no kidney biopsies were performed it was assumed that 34% and 27% of patients had vascular nephropathy and chronic glomerulonephritis, respectively. Of the 385 ESRD patients, only 140 (36.3%) had access to haemodialysis (two sessions/week, 4 hours each). Most patients that received haemodialysis resided within the Conakry region (P < 0.0001). There were significant associations between mortality and (i) terminal stage of CKD (P = 0.0005), (ii) vascular nephropathy (P = 0.002), and (iii) nephropathies of unknown origin (P = 0.0001). Conclusions: A fourfold increase in haemodialysis machines is needed in Conakry, plus four new nephrology/haemodialysis centres within the Republic of Guinea, each holding ≥30 haemodialysis machines

Short-term Multi Horizons Forecasting of Solar Irradiation Based on Artificial Neural Network with Meteorological Data: Application in the North-west of Senegal

International audienceThis study proposes a short term forecasting of solar irradiation with multi horizons in the northwest of Senegal. The multilayer artificial neural network (ANN), based on the Levenberg Marquardt algorithm and the meteorological data are used. The latter are measured in real time on the study site. The variables of interest are: mean solar irradiation, maximum temperature and measurement time; they are selected using Weka software. The forecasting horizons are: 0.5 hour, 1 hour, 1.5 hours, 2 hours, 2.5 hours, 3 hours, 3.5 hours, 4 hours, 4.5 hours, 5 hours, 5.5 hours and 06 hours. They are proposed with the corresponding statistical criteria. The results show that, the solar energy forecasting can be extended over a six-hour horizon with a correlation coefficient of 0.97 and root mean square error of 0.07. These results will make it possible to complete the forecasting tools in the solar energy sector in Senegal, and help investors to choose the most suitable horizons for energy forecasting in photovoltaic solar power plants

Dynamics analysis and factors in landscape units’ evolution in Senegal River delta ecosystems

This study analyzes the relationship between land use units and natural and anthropogenic factors of the Senegal River delta. Remote sensing and GIS data, Landsat images (1977, 1988, 1999, 2006, 2014) show an expansion rate of vegetation cover (64%) crop areas (6.77%), surface water (4%) and regression of salted areas (74.69%) and dune (15.62%) between 1977 and 2014. Increases are due mainly to irrigation schemes, population growth, protection policies and conservation of natural resources. Regressions are related to the development of the agricultural sector and the importance of rainfall-limiting biophysical processes. The article analyzes the data.Great Britain. Dept for International Developmen

Tumeur de Buschke-Lowenstein à localisation ano-périnéale à propos dun cas (Ano-perineal Buschke-Lowenstein tumor: A case report)

La tumeur de Buschke-Lowenstein (TBL) ou le condylome acuminé géant (CAG) est une entité clinique rare atteignant moins de 0,1 % de la population générale. Transmise essentiellement par voie sexuelle, elle est liée à linfection à Human Papilloma Virus (HPV). Elle peut dégénérer en carcinome épidermoïde de lanus plus particulièrement chez les personnes infectées par le VIH. Nous rapportons lobservation dun patient porteur de VIH, avec notion dhomosexualité, reçu pour lésions condylomateuses acuminées ano-périnéales géantes. Lobjectif est de décrire les aspects cliniques, thérapeutiques et évolutifs de cette affection

Avenir du fleuve Niger

Le fleuve Niger constitue un véritable poumon humide pour l’Afrique de l’Ouest et plus spécialement pour la république du Mali. Dans ce pays, la gestion du fleuve constitue un enjeu majeur car on y trouve à la fois de remarquables systèmes de production traditionnels associés au phénomène naturel de crue – sources de moyens d’existence pour des centaines de milliers de personnes – mais aussi de grandes réalisations et promesses en matière d’aménagements modernes, hydroélectriques et hydroagricoles. À l’heure où de nouveaux projets d’équipement arrivent à concrétisation et où d’autres sont annoncés, il est important de faire le point sur l’état de santé de ce fleuve et de peser ce qu’il représente pour ses multiples usagers. Cette expertise collégiale, conduite par l’IRD et l’IER et réalisée avec le soutien de plusieurs institutions d’aide au développement et de défense de l’environnement, traite de ces différents aspects avec pour objectif, d’une part, la clarification des cadres institutionnels et des options de politiques publiques et, d’autre part, le renforcement des outils de suivi et d’aide à la décision.The Niger river is truly the main source of life for Western Africa, more specifically for the Republic of Mali. In the country, management of the river is a key topic, as one can find at the same time remarkable traditional production systems associated with the floods which supply hundreds thousands of people – but also great projects which promise modern installations, hydroelectrical and hydroagricultural systems. As new projects come to their end and others begin, it seems important to make a point regarding the health of the river and to evaluate what it represents for its diverse users, civil society or for the economy of Mali. This is the aim of this expert group review, led by the IRD and the IER, with the support of different development and nature protection institutes. Complementarities as well as oppositions that appear from the interactions between the river’s users are described. For the decision-makers in charge of those problems, different recommendations are made, aiming on one hand to clarify institutional frameworks and policy options, and on the other hand to reinforce management and decision-making tools

Tolon

Music from Burkino Faso played and sung in the griot style commenting on historical and contemporary event

Dramedjeli

Music from Burkino Faso played and sung in the griot style commenting on historical and contemporary event

Fourou

Music from Burkino Faso played and sung in the griot style commenting on historical and contemporary event