Osteoarthritis of the hip in children at the Lome´ Teaching Hospital

Objectives The aim of this study was to describe the epidemiological and therapeutic aspects of osteoarthritis of the hip in children, analyze the outcome, and describe the techniques for its diagnosis in a hospital with poor working conditions.Materials and methods This was a retrospective study including children in the age group of 0–15 years, who were managed for osteoarthritis at the Pediatric Surgery Department of the Lome´ Teaching Hospital (Togo) between July 2000 and June 2008. The data were collated from patients’ records and analyzed for epidemiology, clinical features, treatment, and outcome of osteoarthritis.Results A total of 30 children were included in this study, of whom 17 (24.4%) were girls and 13 (43.3%) were boys. Their mean age was 4 years (range: 1–15 years). Children in the age range of 0–6 years accounted for 73.33% of patients included. Fifteen patients were of the homozygous sickle cell genotype (SS). Treatment included antibiotic therapy and immobilization of the joint. The outcome was excellent in eight AA patients (26.67%); good in three (10%), including one SS, one AS, and one SC; and fair in 19 patients (63.33%), including 14 SS, four AS, and one SC. The average duration of hospital stay was 18 days (range: 2–35 days).Conclusion Sickle cell disease (SS genotype) is the predominant cause of osteoarthritis in children presenting to the Pediatric Surgery Department of the Lome´ Teaching Hospital. Early diagnosis and appropriate treatment are necessary for a complete cure.Keywords: child, hip, osteoarthritis, sickle cell, Tog

Les torsions du cordon spermatique chez l’enfant

Objectif: Evaluer la fréquence des torsions du cordon spermatique, décrire leurs manifestations et leur prise en charge et évaluer les résultats de cette prise en charge au CHU Tokoin de Lomé, Togo. Patients et méthodes: Il s’agit d’une étude rétrospective sur les dossiers de 17 patients pris en charge dans le service de chirurgie pédiatrique du 1er janvier 2002 au 31 décembre 2006 pour torsion du cordon spermatique de diagnostic per opératoire. Les données étudiées étaient l’âge des patients, le délai d’évolution, les symptômes, les examens diagnostiques, le traitement et les résultats postopératoires. Résultats: Durant la période d’étude, nous avons recensé 57 patients présentant une grosse bourse douloureuse dans le service de chirurgie pédiatrique. Parmi eux, 17 ont présenté une torsion du cordon spermatique (29,8%) dont 11 patients étaient âgés de 6 à 15 ans montrant une nette prépondérance de l’âge pubertaire. L’âge moyen de nos patients était de 9 ans (extrêmes de 7 jours et 15 ans). Le délai moyen d’évolution était de 30 heures (extrêmes 10 et 72 heures). La douleur était le symptôme principal chez les nourrissons et les grands enfants. Onze patients sur les 17 ont bénéficié d’un écho doppler. Les gestes chirurgicaux réalisés ont été l’exploration chirurgicale suivie d’une détorsion et d’une fixation des deux testicules. Tous les testicules (17) ont été sauvés. Avec un recul moyen de 12 mois (extrêmes 4 mois et 5 ans), les suites opératoires ont été bonnes. Conclusion: Les torsions du cordon spermatique se voient préférentiellement en période néonatale et à l’adolescence. Cependant elles peuvent se voir entre ces deux périodes. L’exploration chirurgicale doit être systématique devant toute suspicion de torsion du cordon spermatique.Mots clés: Torsion, cordon spermatique, enfant, lomé

Traitement Chirurgical Des Fractures Du Fémur De L’enfant

Objective To describe indications, different modalities and results of surgical treatment of femur fractures in children. Patients and methods This is a retrospective study from January 2004 to December 2013 in the pediatric surgery department of Lomé Sylvanius Olympio teaching hospital, from the records of patients aged 0-15 years with femur fractured treated surgically. Results There were 66.1% (39 cases) of shaft fractures of which 53.57% localized in the middle third. Of the 33.9% (20 cases) of the lower extremity fracture, epiphyseal growth fractures accounted for 13 cases including seven (7) for type II among Salter-Harris classification. The indications were: femoral fracture occurred in the context of multiple trauma (4 cases), patients over 11 years (40 cases), failure of conservative treatment (2 patients), epiphyseal growth fractures of the distal femur after failure of conservative treatment (12 patients) and an epiphyseal growth fracture type 4 of Salter and Harris where surgery was indicated immediately (1 case). The average time of surgical treatment was 32 days. The elastic stable intramedullary nailing (ESIN) was made in 66.1% of patients, the plate in 18.6%, the pinning in 11.9% and screwing in 3.4%. The average duration of hospital stay was 45.16 days. Removal of osteosynthesis material was performed in 38 patients or 64.4% of cases. The average time of this removal was 8 months.Conclusion The methods of the most widely used surgical treatment are open ESIN because of the long waiting patients associated with very limited financial resources. This method has real advantages and should be encouraged in our communities by improving the technical facilities and living conditions of the population

ECRASEMENTS DE MEMBRES DE L’ENFANT MEMBER’S CRUSH INJURIES IN CHILDREN

Objective: To describe the epidemiology, mechanisms of occurrence and therapeutic management of the crushing member’s injuries in children. Materials and methods: It was a retrospective study of the records of patients less than 15 years treated in the Pediatric Surgery Department of the Sylvanus Olympio teaching hospital (Lomé) for crushing members from January 2008 to December 2011. Results: We recorded 15 cases of crushing member’s injuries in children representing 1.7% of hospitalizations for trauma in the pediatric surgery department. The annual incidence was 3.7 cases. There were 7 males and 8 females. The average age of the patients was 8.8 years. Older children accounted for 10 cases (66.7%). Occurrences of accidents were the mechanisms of the public highway with 53.3% (8 cases) and 46.7% (7 cases) for domestic accidents. Five (5) patients had hemodynamic shock at admission. Treatment was radical in 10 patients (66.7%). It was an amputation. Conservative treatment consisted to the cast immobilization in three patients and intra focal osteosynthesis in two (2) patients. A suppuration of amputation stumps was recorded. The average length of hospital stay was 23.17 days (extremes: 1 and 60 days). Conclusion: Members’ crush injuries are relatively uncommon in pediatric units in Togo

ECRASEMENTS DE MEMBRES DE L’ENFANT MEMBER’S CRUSH INJURIES IN CHILDREN

Objective: To describe the epidemiology, mechanisms of occurrence and therapeutic management of the crushing member’s injuries in children. Materials and methods: It was a retrospective study of the records of patients less than 15 years treated in the Pediatric Surgery Department of the Sylvanus Olympio teaching hospital (Lomé) for crushing members from January 2008 to December 2011. Results: We recorded 15 cases of crushing member’s injuries in children representing 1.7% of hospitalizations for trauma in the pediatric surgery department. The annual incidence was 3.7 cases. There were 7 males and 8 females. The average age of the patients was 8.8 years. Older children accounted for 10 cases (66.7%). Occurrences of accidents were the mechanisms of the public highway with 53.3% (8 cases) and 46.7% (7 cases) for domestic accidents. Five (5) patients had hemodynamic shock at admission. Treatment was radical in 10 patients (66.7%). It was an amputation. Conservative treatment consisted to the cast immobilization in three patients and intra focal osteosynthesis in two (2) patients. A suppuration of amputation stumps was recorded. The average length of hospital stay was 23.17 days (extremes: 1 and 60 days). Conclusion: Members’ crush injuries are relatively uncommon in pediatric units in Togo

Experience with Open Prostatectomy in Lomé, Togo

The average blood loss at surgery was 425.92 ± 38.2 ml with an average operating time of 66.05 ± 15.75 mins and the main complications were hemorrhaging and clot retention in 7 (13%), epididymo-orchitis in 9 (16.7%), and urinary incontinence in 6 (11.1%) patients. IPSS scores were under 7 in 92% of patients three months after surgery and the mortality rate was 3.7%. Conclusion: This study has shown that open prostatectomy in our environment is still the commonest surgical option for benign prostatic hyperplasia with good outcomes though with manageable complications

L’osteochondrose deformante tibiale ou maladie d'ehrlacher-blount. A propos de 19 cas.

This retrospective study over 8 years was performed on case histories of 19 black children aged 3 to 15 years (11 boys and 8 girls), suffering from the Blount’s disease. The frequency of the disease was 2.53cases per year. There was a predominance of males with 57.89%. The first and second babies were the most concerned with respectively 42.11% and 31.57%. Precocity of walk was found in 73.68% ofpatients. Excess of weight was found only in 4 children (21.05%): weight superior to the 95% percentile at the moment of diagnosis. Sickle-cell disease was associated to the tibia vara in 7 patients (36.84%). It did not neither worsen nor favour the occurrence of postoperative complications. Other associated pathologies were the coxa vara (2 cases), the syndactyly (1 case) and one case of left inguinoscrotal hernia. The 19 children presented altogether 26 diseased knees; the deformities were mostly obvious because they were seen at a late stage. We noted 8 infantile forms (6 unilateral and 2 bilateral) and 11 juvenile forms (6 unilateral and 5 bilateral). In terms of X-Rays, we noted 7 cases (26.92%) at stage II (3 to 4 years), 5 cases (19.23%) at stage III (5 to 8 years), and 14 cases (53.85%) at stage IV (9 to 11 years). Valgisation osteotomy by external substration was performed in 3 patients (4 knees) who had lesions at stage II without ligamentary hyperlaxity. In the 16 other patients (22 knees), we realised a raising-up osteotomy of the internal tibial tray with iliac autograft, associated with an external epiphysiodesis.The results were satisfactory in the majority; in the first group, a knee stayed unstable inspite of the iterated osteotomy ; in the second group, two cases of length inequality of the lower limbs were noted and corrected with orthopedic bindings. Une étude rétrospective sur 8 ans a porté sur 19 enfants noirs, âgés de 3 à 11 ans (11 garçons et 8 filles), atteints de la maladie d'Ehrlacher-Blount, dans le but d’en préciser les caractéristiques épidémiologiques,cliniques et thérapeutiques et d’en préciser la relation avec la drépanocytose. La fréquence de l'affection a été de 2,53 cas par an. La précocité de la marche a été retrouvée chez 73,68 % des patients. L’excès de poids n'a été retrouvé que chez 4 enfants : poids supérieur au 95ème percentile. La drépanocytose a été associée chez 7 patients. Elle n'a pas précipité l'apparition de la déformation. Elle ne l'a pas aggravée ni n'a favorisé l'apparition des complications post opératoires. Les 19 enfants ont présenté au total 26 genoux malades. Il y a eu 8 formes infantiles et 11 formes juvéniles. Radiologiquement, on a noté 7 cas au stade II, 5 au stade III et 14 au stade IV. L'ostéotomie devalgisation par soustraction externe a été effectuée chez 3 malades (4 genoux) ayant des lésions au stade II. Les 16 autres malades (22 genoux) ont bénéficié d'une ostéotomie de relèvement du plateau tibialinterne avec autogreffe iliaque, et épiphysiodèse latérale. Les résultats ont été en majorité satisfaisants ; dans le premier groupe, un genou est resté instable malgré l'ostéotomie itérative ; dans le deuxièmegroupe, il y a eu deux cas d'inégalité minime de longueur des membres inférieurs. Une prise en charge précoce s’avère le meilleur moyen d’obtenir de meilleurs résultats

Les encephaloceles au Chu Tokoin de Lome

Objective: To value the epidemiological aspects and the management of the encephaloceles at the Tokoin teaching hospital.Patient and method: A 18 years review of 9 infants with encephalocele was carried out in the Tokoin teaching hospital between 1987 and 2004.Results: From January 1987 to December 2004, 61 children have been received in pediatric surgery department of the Tokoin teaching hospital (Lome) for neural tube defect (NTD). The NTD included 48cases of spina bifida, 9 cases of encephalocele and 4 cases of anencéphaly. The encéphalocèles represented 14.75% of the NTD with a frequency of 1 case every 2 years. The middle age of the patientswas 14.22 days with extremes of some hours and 60 days. The sex ratio was 0.8. The folic acid consumption was not efficient at the mothers of the patients. Seven of the patients had occipitalencephalocele. The associated malformations were: spina bifida (1 case), rounded forehead associated with a polydactyly (1 case) and microcephaly associated with a syndactyly (1 case). Eight (8) patientshad benefitted a surgical cure of the encephalocele. A patient died at birth. The middle delay of the surgical cure outside of the deceased patient was about 4 months (range 1-11 months). The operativecontinuations were good at 7 patients.Objectifs : Evaluer les aspects épidémiologiques et la prise en charge des encéphalocèles au CHU TokoinPatients et méthode : C’est une étude rétrospective qui a porté sur 9 cas d’encéphalocèle pris en charge dans le service de chirurgie pédiatrique du CHU Tokoin de Lomé entre janvier 1987 et décembre 2004.Résultats : En 18 ans, 61 enfants ont été reçus en consultation de chirurgie pédiatrique pour un défect du tube neural (DTN) dont 48 cas de spina bifida, 9 cas d’encéphalocèle et 4 cas d’anencéphalie. Lesencéphalocèles ont représenté 14,75% des DTN avec une fréquence de 1cas tous les 2ans. L’âge moyen des patients à la consultation était de 14,22 jours avec des extrêmes de quelques heures et 60 jours. Lasexe ratio était de 0,8. La prise d’acide folique n’a pas été effectuée chez les mères des patients. Dans 7 cas, l’encéphalocèle siégeait dans la région occipitale. Les malformations associées ont été : spina bifida(1 cas), front bombé associée à une polydactylie (1cas) et  microcéphalie associé à une syndactylie (1 cas). Sur le plan thérapeutique, huit (8) patients avaient bénéficié d’une cure chirurgicale de l’encéphalocèle. Un patient était décédé à la naissance. Le délai moyen de la cure chirurgicale en dehors du patient décédé a été de 4 mois avec des extrêmes de 1 et 11 mois. Les suites opératoires ont été bonnes chez 7 patients

Aspects epidemiologiques et diagnostiques des stenoses caustiques de l’oesophage au Togo

Objective: To determine the frequency, the incidence and the diagnosis aspects of caustic’s stenoses of esophagus, for better therapeutics care.Methods: It is retrospective surgery on folders at nine surgical departments in Togo for a period of 11 years.Results: Two hundred and ninety six out of 5253 patients admitted within 11 years (5.63%) for caustic’s products ingestion have had caustic’s stenoses of esophagus. The annual incidence was 26.91 cases per year. Most of patients were male with a sex ratio of 1,41. Themiddle age of our patients was 27 years. The majority of the patients belong to moderate social and economical class. Bases (41.22)% were the most caustic’s products incriminated , follows by acids (21.96%). The clinical symptomatologies were dominated by dysphagia (100%). Digestive endoscopy was realised in 83.78% cases and the eso-gastro-duodenal transit in 100% cases.Conclusion: The esophageal caustic’s stenoses are still serious diseases. It has been essentially caused by ingestion of bases products, mostly for suicide

Chirurgie sous-ombilical chez l’enfant en milieu tropical : évaluation d’un PROTOCOLE d’anesthésie caudale réalisée par les infirmiers anesthésistes au CHU de Lomé (Togo)

Objectif : Evaluer la pratique de l’anesthésie caudale réalisée par les infirmiers anesthésistes (ISAR) au CHU de Lomé (Togo). Matériel et Méthodes: Etude prospective réalisée de mai 2007 à juin 2008. Après accord du comité éthique de l’hôpital, les données démographiques et médicales, le type et la durée de la chirurgie, le protocole anesthésique et le bénéfice analgésique post opératoire, ont été analysés chez des patients de moins de 8ans ayant bénéficié d’une anesthésie caudale (AC) administrée par les ISAR au bloc de chirurgie pédiatrique du CHU-Tokoin de Lomé. Résultats : Quarante trois enfants ASA1 ont été retenus pour une anesthésie caudale durant la période de l’étude. L’âge moyen était de 18 mois ± 4 mois et le poids moyen de 9 kg ± 5 Kgs. Le sexe masculin prédominait (98% des cas). Trente trois (76,7%) circoncisions, 4 (9,3%) cures herniaires, deux cures d’hydrocèle, une orchidopexie, deux urétroplasties et une cure d’ectopie testiculaire ont été réalisées. La bupivacaïne 0,25% à raison de 1ml/kg était utilisée seule sans adjuvant. Le volume moyen était 8,4 ± 3 ml. L’induction et l’entretien ont été faits avec l’halothane dans 98% des cas. Le délai moyen d’installation du bloc était de 10 ± 4 min. La durée moyenne de la chirurgie était de 34,1 min. seuls deux patients (4,65%) ont eu besoin d’un supplément d’analgésie, l’un à la 12e heure et l’autre à la 16e heure post opératoires et aucun patient n’était algique à la 24e heure. Deux cas (4,65%) d’échec total du bloc caudal ont été enregistrés et convertis en anesthésie générale. Aucune complication majeure n’a été enregistrée. Conclusion : Cette étude montre que la pratique du bloc caudal par les infirmiers anesthésistes au CHU Tokoin de Lomé semble satisfaisante mais nécessite une formation complémentaire et un meilleur encadrement. En raison de son efficacité à modeste coût, le bloc caudal est une technique anesthésique intéressante dans les pays en développement. Malgré sa simplicité de réalisation il nécessite un apprentissage, un respect des contre-indications et une évaluation du bénéfice-risque pour le patient.Mots clés : bloc caudal, analgésie pédiatrique, infirmiers anesthésistes, Togo.Objective: Evaluate caudal anesthesia practice realized by nurse anesthetists at Lome Teaching Hospital. Materiel and Methods: It was a prospective survey during May 2007 to June 2008. After approval of hospital ethic committee, medical and demographic data, surgical practice, anesthetic procedure and post operative analgesia benefit were analyzed in children aged under 8years. Results: Forty tree patients were included in our study. The average age and weight were respectively 18 months and 9 Kgs.The extremes were 1 month and 7 years for the age, and the weight was varying between 4 and 24 Kgs. There were 98% male patients. Thirty three (76.7%) circumcisions, 4 (9.3%) herniorrhaphies, 2 cures of hydrocele,on e orchidopexy,2 uretroplasties,and one cure of testiculary ectopy,were performed. The average duration of surgery was 34.1 min. All patients were ASA1. The bupivacaïne 0.25% was used at an average volume of 8, 4 ml. In 98% anesthesia was induced and maintained with halothane in oxygen. Surgery was allowed to begin under 10 min after performing the block in 63.4%. Amiel-Tison scale was used to evaluate postoperative pain in 73% versus 27 for CHEOPS’s. Two patients (4.6%) needed additional analgesia 12th and 16th hours after surgery, and no patient was algic at 24th hour postoperatively. Two (4.7%) totally failed caudal block occurred. Conclusion: This study shows that the practice of caudal block by nurse anesthetists seems satisfactory in our context, but needs more training and supervision. Caudal analgesia seems to be an important technique in developing country, with a real benefit and a moderate cost.Key words: Caudal block, pediatric analgesia, nurse anesthetists, Togo