Criteres Du Traitement Non Operatoire Des Contusions Abdominales En Milieu Sous Equipe

The criteria of non-operative operative management (NOM) of blunt abdominal trauma remains poorly defined in the context of low-income countries. Purpose: To validate a protocol for blunt abdominal trauma by specifying indications for NOM in a resource-limited setting. Material and Method: The study was prospective, carried out over a period of 12 months at Sylvanus Olympio Teaching Hospital Lomé (Togo). It included all patients over 15 years admitted for abdominal blunt trauma. Patients were subjected to NOM or surgery according to systolic blood pressure, response to resuscitation measures, clinical examination, peritoneal tap, abdominal plain radiograph and ultrasound. Results: Sixty-four patients, including 53 men and 11 women, were admitted in the study. The mean age was 27.8 years. Road traffic accidents were the circumstance of the occurrence in all cases. Pneumopéritoneum was found in 3 patients (5.45%). Abdominal ultrasound identified a solid organ injury in 24 patients (43.6%). Spleen lesions were the most frequent injuries. An extra-abdominal lesion was present in 23 patients (35.9%). NOM was initiated in 52 patients (81.25%) and effective in 46 patients (88.4%). The failure of the NOM was due to small intestine perforation in 2 patients, a bladder injury in 1 patient, active bleeding in 1 patient and hemodynamic instability resulting in nontherapeutic laparotomy in 2 patients. Death was observed in 8 patients (12.5%), 2 of whom were in the NOM group. Conclusion: criteria for the NOM of blunt abdominal trauma can be defined according to the local possibilities. Early diagnosis of digestive perforation should remain a priority during clinical monitoring

Penile Ectopic Testis (PET) Case Report in Adulthood in Rural Area of Africa: An Uncommon Cause of Dyspareunia

Penile ectopic testis is a rare congenital abnormality with an etiopathogenesis poorly understood nowadays. We report a case of a 19 years old boy admitted for left groin hernia with dyspareunia whose management in rural area consisted in an orchidopexy in dartos completed by a normal sperm count and a normal testicular biopsy

Épidémiologie des amputations non traumatiques des membres inférieurs enAfrique de l'Ouest : Données nationales du Togo

International audienceIntroduction - L'amputation non traumatique d'un membre inférieur (ANT-MI), a desconséquences majeures. Les données en population générale en Afrique subsaharienne(ASS) sont rares et souvent liées à des séries monocentriques. Notre étude visait à estimerl'incidence des ANT-MI (mineures et majeures) et à décrire leurs aspects épidémiologiques,cliniques et pronostiques au Togo.Méthodes - Il s'est agi d'une étude rétrospective, menée auprès de tous les patients ayantsubi une ANT-MI. Les données sociodémographiques, cliniques et de bilan ont été recueilliesà partir des dossiers cliniques dans toutes les formations sanitaires togolaises du 01/01/2016au 31/12/2021. Les taux d'incidence par âge ont été calculés et ajustés sur l'âge.Résultats - Au total, 352 patients (59% d'hommes) ont subi une ANT-MI (âge moyen de 60 ±15,7 ans). Le taux d'incidence moyen des ANT-MI ajusté sur l'âge était de 8,5 par million/an(IC 95%= [7,6-9,4]). Le risque relatif d’ANT-MI était 48 fois plus élevé chez les diabétiques quechez les non-diabétiques. Environ 61% des ANT-MI sont survenus dans la tranche d'âge 50-74 ans et 54,3% étaient atteints de diabète sucré. Parmi les amputés, 54,5% souffraientd’artériopathie oblitérante des membres inférieurs (AOMI) et 52,8% souffraient d'ulcèresdiabétiques, avec la coexistence de plusieurs facteurs. Seuls <5% des amputés avaient desantécédents de tabagisme. La durée moyenne du séjour à l'hôpital était de 12 jours. Le tauxde mortalité à l'hôpital était de 8,8% Seulement 18,2% ont eu une échographie et 1,7% unangioscanner avant l'amputation.Conclusion - Des interventions à grande échelle sont nécessaires pour améliorer la prise encharge du diabète et de l’AOMI et améliorer les infrastructures pour une prise en chargeoptimale des patients à risque d'amputation en Afrique

Dressings for the prevention of surgical site infection

BACKGROUND: Surgical wounds (incisions) heal by primary intention when the wound edges are brought together and secured - often with sutures, staples, clips or glue. Wound dressings, usually applied after wound closure, provide physical support, protection from bacterial contamination and absorb exudate. Surgical site infection (SSI) is a common complication of surgical wounds that may delay healing. OBJECTIVES: To evaluate the effects of wound dressings for preventing SSI in people with surgical wounds healing by primary intention. SEARCH METHODS: We searched the CochraneWounds Group Specialised Register (searched 10May 2011); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011 Issue 2); OvidMEDLINE (1950 to AprilWeek 4 2011); OvidMEDLINE (In-Process & Other Non-Indexed Citations, May 9, 2011); Ovid EMBASE (1980 to 2011 Week 18); EBSCO CINAHL (1982 to 6 May 2011). There were no restrictions based on language or date of publication. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing alternative wound dressings or wound dressings with leaving wounds exposed for postoperative management of surgical wounds healing by primary intention. DATA COLLECTION AND ANALYSIS: Two review authors performed study selection, risk of bias assessment and data extraction independently. MAIN RESULTS: Sixteen RCTs were included (2578 participants). All trials were at unclear or high risk of bias. Nine trials included people with wounds resulting from surgical procedures with a contamination classification of ’clean’, two trials included people with wounds resulting from surgical procedures with a ’clean/contaminated’ contamination classification and the remaining trials evaluated people with wounds resulting from various surgical procedures with different contamination classifications. Two trials compared wound dressings with leaving wounds exposed. The remaining 14 trials compared two alternative dressing types. No evidence was identified to suggest that any dressing significantly reduced the risk of developing an SSI compared with leaving wounds exposed or compared with alternative dressings in people who had surgical wounds healing by secondary intention. AUTHORS’ CONCLUSIONS: At present, there is no evidence to suggest that covering surgical wounds healing by primary intention with wound dressings reduces the risk of SSI or that any particular wound dressing is more effective than others in reducing the rates of SSI, improving scarring, pain control, patient acceptability or ease of dressing removal. Most trials in this review were small and of poor quality at high or unclear risk of bias. However, based on the current evidence, we conclude that decisions on wound dressing should be based on dressing costs and the symptom management properties offered by each dressing type e.g. exudate management.Jo C. Dumville, Catherine J. Walter, Catherine A. Sharp and Tamara Pag