CT pelvimetry of variant pelvis and child birth prognosis

The aim of this study was to determine the threshold values of pelvimetry by scanning and to evaluate the ability of the pelvimetry alone to diagnose a fetal-pelvic disproportion. It was an observational retrospective study on 410 pregnant women who had a scanner pelvimetry for any reasons. Based on the fetal presentations, two subgroups (breech and cephalic -others) have been defined. Measurements of the main obstetric diameters (promonto-retropubic, median transverse and dual sciatica) were taken. The 5th and 10th percentile were calculated as well as the 90th and 95th to determine the threshold values of pelvimetry by scanner. The scanner values found on CT were compared with the standard X ray pelvimetry values. Referring to extreme values obtained by pelvimetry scanner, some pathological pelvic brim were reconstructed in 3D. Moreover, the delivery prognostic was analyzed by crossing the pelvic inlet dimensions (Magnin index) and pelvic outlet dimensions (bi-sciatic diameter) with the outcome of the delivery. The mean values of the scanno-pelvimetry measurement in our series were:m12,39 cm (± 1) for the promonto-retropubic diameter, 12.88 cm (± 1.01) for the transverse median diameter and 11 cm (± 1.32) for the bi-sciatic diameter. These measurements provided an accuracy less than 1 cm compared to the standard ray pelvimetry. Although Magnin index at 23 allows a vaginal delivery, 51% of oursample have failed. Moreover, for the Magnin index at 24 and 25, the vaginal delivery failure rate remains high:45.1% and 39.61% respectively. Compared to classical pelvimetry, pelvimetry by scanner provides additional precision and allows to study the geometry of the basin. However, the pelvimetry alone could not be effective to establish the prognosis of vaginal delivery.Keywords: scanno-pelvimetry, prognosis, deliver

Hydranencephalie a Cotonou (Benin) a propos de 3 cas cliniques

L’hydranencéphalie est une malformation rare du système cérébral. Elle est caractérisée par une disparition des hémisphères cérébraux bilatéraux qui sont remplacés par le liquide céphalorachidien. Nous rapportons 3 cas cliniques. Le diagnostic repose sur le scanner cérébral et l’IRM et pose un problème thérapeutique et éthique car aucun traitement n’améliore le développement neurologique.Mots-clés: hydranencéphalie, hydrocéphalie, malformation, système nerveux central, BéninEnglish Title: Hydranencephaly at Cotonou (Benin): 3 cases reportsEnglish AbstractHydranencephaly is a rare malformation of the brain system. It is characterized by the absence of bilateral cerebral hemispheres which are replaced by cerebrospinal fluid. We present three clinical cases. Brain CTscan was performes for diagnosis. Therapeutic and ethic problems are discussed.Keywords: hydranencephaly, hydrocephalus, malformation, central nervous system, Beni

Prise en charge des traumatismes cranio-encephaliques chez les enfants a Cotonou

Introduction En Afrique les maladies infectieuses restent les premières préoccupations des politiques de santé. Cependant l’augmentation du parc automobile et le changement du mode de vie entraînent une augmentation des traumatismes en général et en particulier chez les enfants. Les traumatismes crâniens constituent les principales lésions létales. Notre objectif était d’étudier les causes, les données sociodémographiques, cliniques et thérapeutiques.Patients et méthodes Il s’agissait d’une étude rétrospective descriptive allant de juillet 2012 à décembre 2013 au Centre National Hospitalier Universitaire de Cotonou. Elle incluait tous les enfants de 0 à 16 ans victimes de traumatisme crâniens admis durant cette période. L’analyse des données a été faite par le logiciel Stata 11.Résultats Nous avons recensé 102 enfants avec une moyenne d’âge de 5,59 ans, la sex-ratio était de 1,4. Les accidents de la circulation étaient les principales causes (62,75%) suivis des accidents domestiques. Les traumatismes étaient bénins dans 53, 92 % des cas, modérés dans 36,84% et graves dans 11,7 % des cas. Le traitement chirurgical a été faite chez 36,27% des enfants. La mortalité était de 1,8 % parmi les traumatismes crâniens bénins, 5,7% parmi les modérés et de 66,66 % parmi les cas graves.Conclusion Les accidents de la circulation constituent la cause majeure des traumatismes crâniens au Bénin. La prise en charge des traumatismes crâniens graves nécessite la mise en place d’une politique de santé facilitant l’organisation des soins

Computed tomography morphometric comparison of the pelvis in children with and without rectal prolapse in Niger

Background: Rectal prolapse is a public health problem that affects all sexes at different ages. It is one of the most frequent reasons for consultation in pediatric surgery. The main causes are chronic constipation and diarrhea or both. The increase in abdominal pressure, whatever its cause, is an essential factor favoring the occurrence of rectal prolapse. The anatomical factors related to the morphology of the pelvis and sacrum are unknown. The objective of this work was to compare the morphometric variations of the pelvis in children aged from 0 to 15 years with and without rectal prolapse. Methods: This was a case-control study of 128 children (64 males) living in Niger, children without rectal prolapse (controls) were paired to those with rectal prolapse by age for both sexes. Morphometric parameters were measured on computed tomography scans. The length, concavity and slope of the sacrum were measured. Antero-posterior, bi-ischiatic, and sub-sacro-sub-pubic diameters were measured on the pelvis. Results: In girls and boys with rectal prolapse, with the generalized linear model the sacral length was significantly increased with p = 0.0005 and sacral concavity decreased as compared with controls with p = 0.0007. The sacral slope has probably also an effect but impaired by large variations. There were no significant changes in other pelvic parameters. Conclusion: The morphology of the sacrum is an anatomical factor probably related to the occurrence of rectal prolapse in children