Résultats De 5ans De Thyroïdectomie Au Service D’orl Et Chirurgie Cervico-Faciale De l’Hôpital National De Niamey (Niger)

Purpose: To evaluate the results of thyroidectomy in the Oto-RhinoLaryngology and Neck Surgery office of the National Hospital of Niamey in Niger. Materials and methods: we analyzed the epidemiological aspects, the indications, the technics and the evolution of thyroidectomy through a retrospective and descriptive study conducted from January 2010 to December 2015. Results: Thyroidectomy represents 8, 51% (n = 236/2773) of the ENT operative activities and an average of 47.2 cases per year for 5 years. Among the patients, there were 15 men and 221 women, a sex ratio of 0.17. The mean age was 37.25 years (extreme 22 and 61 years). The operative indications are dominated by multinodular goiter euthyroid (43.22%), thyroid nodules (39.40%), hyperthyroidism (goiter and Basedow) and substernal goiters, respectively, representing 8.90% and 6.35%. The gestures performed were subtotal thyroidectomy in 56 cases (23.73%), complete thyroidectomy in 85 cases (36.02%) and lobo-isthmectomy in 95 cases (40.25%). The recurrent nerve was searched in 235 cases (99%) and found in 215 cases (91, 10%). It was found 1 case (0.42%) of splitting of the left nerve recurrent. 2 cases (0.84%) of immediate postoperative hemorrhage was recorded. Morbidity was 0.29% with 4 cases of definitive unilateral recurrent paralysis and 3 cases of transient hypoparathyroidism. No mortality was encountered. Conclusion: The thyroidectomy is a frequent intervention in the ENT and Neck Surgery office of the National Hospital of Niamey. Multinodular goiter remains the first surgical indication. Recurrent and hypoparathyroid morbidity was very low

Prise En Charge Des Plaies Pénétrantes De L’abdomen À L’hôpital National De Niamey

Objectif : rapporter les résultats de la prise en charge des plaies pénétrantes de l’abdomen à l’hôpital national de Niamey au Niger. Patients et méthodes : il s’agissait d’une étude rétrospective et descriptive sur une période de 2 ans. L’étude a concerné tous les patients de tout âge pris en charge à l’hôpital national de Niamey pour plaie pénétrantes de l’abdomen. Résultats : l’étude incluait 51 patients, soit 0,88% des traumatismes. Il s’agissait de 6 femmes et 45 hommes, soit un sex ratio de 7,5. L’âge moyen des patients était de 28 ans [±10,2]. Le délai moyen d’admission était de 4,86 heures [±2,08]. Dans 84,32% des cas les patients étaient transportés à l’hôpital dans un véhicule non médicalisé. Les agressions représentaient 78,44% des circonstances de survenue et la plaie abdominale s’intégrait dans un contexte de polytraumatisme chez 21,53% des patients. Une éviscération était présente chez 31,37% des patients. Le traitement était opératoire chez 90,19% des patients avec 19,56% de laparotomie non thérapeutique. L’organe le plus lésé était l’intestin grêle dans 31,37% des cas suivi du colon dans 23,52% des cas. La morbidité globale était de 33,37% dominée par les hémorragies postopératoires dans 8,69% des cas. La mortalité était de 13,73% avec 50,14% de décès en postopératoire immédiat par hémorragie secondaire ; 28,58% de décès par retard de l’hémostase chirurgicale et 14,28% de décès par défaut de compensation des pertes sanguines en urgence.Conclusion : les plaies de l’abdomen sont fréquentes chez l’adulte jeune de sexe masculin. Elles sont souvent dues à une agression par armes blanches avec un taux élevé de décès. Objective: to report the results of the management of the penetrating abdominal wounds at the national hospital of Niamey. Patients and method: it was a retrospective and descriptive study over 2 years. The study included the patients of all ages managed for penetrating abdominal wounds at national hospital of Niamey in Niger. Results: the study includes 51 patients whether 0.88 % of trauma. They were 45 men and 6 women, with a sex ratio of 7.5. The average age was 28 [±10.2] years old. The average intake time was 4.86 [2.08] hours. In 84. 32% of cases, patients were transported to the hospital in non-medical vehicle. The assault accounted for 78.44% of the circumstances of the occurrence and the penetrating abdominal wound was integrated into a polytrauma in 21.53% of cases. An evisceration was present in 31.37 % of cases. The management was operative in 90.19% of cases with 19.56% of non-therapeutic laparotomy. The most injured organ was the small intestine in 31.37% of cases followed by the colon in 23.52% of cases. The overall morbidity was 33.37%, dominated by postoperative hemorrhages in 8.69% of cases. The mortality was 13.73% with 50.14% of immediate deaths by secondary hemorrhage, 28.58% of deaths by delay of the surgical hemostasis and 14.28% of deaths by a failure of compensation of the blood losses in emergency room. Conclusion: the penetrating abdominal wounds are common in young adult males. They are often due to a stabbing assault with a high death rate

Ileus Biliaire : A Propos D’un Cas Clinique

Introduction: Gallstone ileus is a rare mechanical occlusion. It is caused by the enclosure of biliary macro lithiasis in a portion of the digestive tract resulting from a digestive bile fistula. We report a clinical case to discuss therapeutic modalities through a review of the literature. Medical observation: We report the case of a 77-year-old patient who was hospitalized in the Nephrology department of the university hospital in Montpellier for functional kidney failure and dehydration from vomiting and diarrhea. The none-injected abdominal-pelvic CT scan showed a gallstone ileus with 5 enclaved duodenum, jejunum and ileum lithiasis resulting into a small bowel obstruction. There are no signs of acute cholecystitis. The management was simple by enterolithotomy surgery alone after fixing of hydro electrolyte imbalance. The after surgery sequence was simple. Conclusion: Gallstone ileus is a rare surgical condition. The high mortality rate in the management of this condition makes enterolithotomy the least invasive and recommended method

Prise en Charge des Appendicites Compliquées de l’Adulte à l’Hôpital National de Niamey

Objectif : rapporter les résultats de la prise en charge des appendicites compliquées chez l’adulte à l’Hôpital National de Niamey (HNN). Patients et méthode : Il s’agissait d’une étude rétrospective, descriptive et analytique sur 10 ans incluant tous les patients âgés de plus de 15 ans qui avaient été pris en charge pour appendicites compliquées à l’HNN. Résultats : durant la période de l’étude 8127 urgences abdominales avaient été enregistrées dont 1837 d’origine appendiculaire, parmi elles 512 étaient des appendicites compliquées (AC), soit 6, 30% des urgences abdominales et 27, 87% des appendicites. Il s’agissait de 337 (65, 82%) hommes et 175 (34, 18 %) femmes ; soit un sex ratio de 1, 92. L’âge moyen des patients était de 32, 83 [±14, 50] ans avec des extrêmes de 16 ans et de 90 ans. Le délai moyen d’admission était de 6 [±3, 82] jours avec des extrêmes de 1 et de 14 jours. Les AC retrouvées étaient la péritonite appendiculaire dans 74, 02% des cas (n =379) suivie de l’abcès appendiculaire dans 21, 48% des cas (n=110) et du plastron appendiculaire dans 4, 5%(n=23) des cas. Le traitement avait été opératoire dans 95, 5% des cas (n = 489). La voie d’abord utilisée était la laparotomie médiane dans 81, 05% des cas (n=415) et l’appendice était gangréné dans 95, 70% des cas (n=490) à l’exploration. Le geste le plus réalisé était l’appendicectomie dans 89, 84% des cas (n= 460). La durée moyenne d’hospitalisation était de 9 [±10, 61] jours avec des extrêmes d’un et de 76 jours. La morbimortalité globale était de 11, 52% avec 9, 96% de suppuration pariétale (n=51) et une mortalité de 1, 56% (n = 8) tous enregistrés parmi les cas de péritonite appendiculaire. Il existe une corrélation significative entre le type de complications et le délai d’admission (P=0, 00001).  Conclusion : Les appendicites compliquées sont fréquentes à l’HNN avec une morbimortalité importante. Le retard de la prise en charge constitue un facteur influencant la survenue des complications.   Objective: to report the results of the management of complicated appendicitis in adults at the National Hospital of Niamey (NHN). Patients and method: This was a retrospective, descriptive and analytical study over 10 years including all patients over the age of 15 who had been treated for complicated appendicitis at NHN. Results: during the study period, 8127 abdominal emergencies were recorded, of which 1837 were of appendicular origin, among them 512 were complicated appendicitis, i.e. 6.30% of abdominal emergencies and 27.87% of appendicitis. These were 337 (65.82%) men and 175 (34.18%) women; i.e. a sex ratio of 1.92. The mean age of the patients was 32.83 [±14.50] years with extremes of 16 and 90 years. The average admission time was 6 [±3.82] days with extremes of 1 and 14 days. Complicated appendicitis found was appendicular peritonitis in 74.02% of cases (n=379) followed by appendicular abscess in 21.48% of cases (n=110) and appendicular plastron in 4.5% (n= 23) cases. The treatment was operative in 95.5% of cases (n = 489). The approach used was the midline laparotomy in 81.05% of cases (n=415) and the appendix was gangrenous in 95.70% of cases (n=490) on exploration. The most performed procedure was appendectomy in 89.84% of cases (n = 460). The average duration of hospitalization was 9 [±10.61] days with extremes of one and 76 days. The overall morbidity and mortality was 11.52% with 9.96% parietal suppuration (n=51) and a mortality of 1.56% (n=8) all recorded among the cases of appendicular peritonitis. There is a significant correlation between the type of complications and the admission time (P=0.00001). Conclusion: Complicated appendicitis is common in NHN with significant morbidity and mortality. Delay in treatment is a factor influencing the occurrence of complications

Prise en Charge des Appendicites Compliquées de l’Adulte à l’Hôpital National de Niamey

            Objectif : rapporter les résultats de la prise en charge des appendicites compliquées chez l’adulte à l’Hôpital National de Niamey (HNN).   Résultats : Pendant  la période de l’étude 8127 urgences abdominales avaient été enregistrées dont 1837 d’origine appendiculaire, parmi lesquelles  512 étaient des appendicites compliquées, soit 6,3 % des urgences abdominales et 27,9 % de toutes les pathologies appendiculaires. Il s’agissait de 337 (65,8 %) hommes et 175 (34,2 %) femmes ; soit un sex ratio de 1,9. L’âge médian des patients était de 30 ans, avec 75% de patients d’âge inférieur ou égal à 40 ans (3è quartile=40 ans) ainsi que des extrêmes allant de 16 ans et de 90 ans. Le délai d’admission  médian était   de 5 jours (Q1=3, Q3=7) avec un taux de 49,6 %(n=254) de patients  admis après 48 heures. Les appendicites compliquées retrouvées étaient la péritonite appendiculaire dans 74 % des cas (n=379) suivie de l’abcès appendiculaire dans 21,5 % des cas (n=110) et du plastron appendiculaire dans 4,5%(n=23) des cas. La chirurgie était pratiquée dans  95,5% des cas (n = 489). La voie d’abord utilisée était la laparotomie médiane sus et sous ombilicale dans 81 % des cas (n=415) et l’incision de Mac Burney dans 14,5%(n=74). L’appendice était gangréné dans 95,7 % des cas (n=490) à l’exploration. Le geste  réalisé était l’appendicectomie dans 89,9 % des cas (n= 460).  L’étude rapporte que 93,3%(n=478) des patients avaient un séjour total (pré et postopératoire)  ≤ 10 jours avec des extrêmes allant d’un jour et de 76 jours d’hospitalisation. La morbimortalité globale était de 11,5 %(n= 59). La suppuration pariétale était retrouvée dans 10 % des cas (n= 51). La  mortalité  était de 1,5 % (n = 8) tous enregistrés parmi les cas de péritonite appendiculaire. Le séjour hospitalier total (initial et post-appendicectomie) variait de un(1) jour à 76 jours ; 93,36%(n=478) avaient un séjour ≤ 10 jours. La médiane de séjour hospitalier était de 14,5 jours ; 75% des patients passaient moins de 28 jours en hospitalisation (3è quartile=28 jours).  Conclusion : Les appendicites compliquées sont fréquentes à l’HNN avec une morbimortalité importante. Le retard de la prise en charge constitue un facteur influencant la survenue des complications.                 Objective : To report the results of the management of complicated appendicitis in adults at the National Hospital of Niamey (HNN). Patients and method: This was a 10-year retrospective, descriptive, and analytical study including all patients over 15 years of age who had been managed for complicated appendicitis at HNN. Results: During the study period, 8127 abdominal emergencies were recorded, of which 1837 were of appendicular origin, of which 512 were complicated appendicitis, i.e. 6.3% of abdominal emergencies and 27.9% of all appendicular pathologies. These were 337 (65.8%) men and 175 (34.2%) women; i.e. a sex ratio of 1.9. The median age of patients was 30 years, with 75% of patients less than or equal to 40 years of age (3rd quartile=40 years) as well as extremes ranging from 16 years to 90 years. The median time to admission was 5 days (Q1=3, Q3=7) with a rate of 49.6% (n=254) of patients admitted after 48 hours. Complicated appendicitis was appendicular peritonitis in 74% of cases (n=379) followed by appendicular abscess in 21.5% of cases (n=110) and appendicular plastron in 4.5% (n=23) of cases. Surgery was performed in 95.5% of cases (n = 489). The approach used was median laparotomy above and subumbilical laparotomy in 81% of cases (n=415) and Mac Burney incision in 14.5% (n=74). The appendix was gangrenous in 95.7% of cases (n=490) on exploration. Appendectomy was performed in 89.9% of cases (n=460).  The study reports that 93.3% (n=478) of patients had a total stay (pre and postoperative) ≤ 10 days with extremes ranging from one day and 76 days of hospitalization. Overall morbidity mortality was 11.5% (n=59). Parietal suppuration was found in 10% of cases (n=51). Mortality was 1.5% (n=8), all recorded among cases of appendicular peritonitis. Conclusion: Complicated appendicitis is common at NNH with significant morbidity mortality. Delayed treatment is a factor influencing the occurrence of complications.&nbsp

Prise en Charge des Appendicites Compliquées de l’Adulte à l’Hôpital National de Niamey

Objectif : rapporter les résultats de la prise en charge des appendicites compliquées chez l’adulte à l’Hôpital National de Niamey (HNN). Patients et méthode : Il s’agissait d’une étude rétrospective, descriptive et analytique sur 10 ans incluant tous les patients âgés de plus de 15 ans qui avaient été pris en charge pour appendicites compliquées à l’HNN. Résultats : durant la période de l’étude 8127 urgences abdominales avaient été enregistrées dont 1837 d’origine appendiculaire, parmi elles 512 étaient des appendicites compliquées (AC), soit 6, 30% des urgences abdominales et 27, 87% des appendicites. Il s’agissait de 337 (65, 82%) hommes et 175 (34, 18 %) femmes ; soit un sex ratio de 1, 92. L’âge moyen des patients était de 32, 83 [±14, 50] ans avec des extrêmes de 16 ans et de 90 ans. Le délai moyen d’admission était de 6 [±3, 82] jours avec des extrêmes de 1 et de 14 jours. Les AC retrouvées étaient la péritonite appendiculaire dans 74, 02% des cas (n =379) suivie de l’abcès appendiculaire dans 21, 48% des cas (n=110) et du plastron appendiculaire dans 4, 5%(n=23) des cas. Le traitement avait été opératoire dans 95, 5% des cas (n = 489). La voie d’abord utilisée était la laparotomie médiane dans 81, 05% des cas (n=415) et l’appendice était gangréné dans 95, 70% des cas (n=490) à l’exploration. Le geste le plus réalisé était l’appendicectomie dans 89, 84% des cas (n= 460). La durée moyenne d’hospitalisation était de 9 [±10, 61] jours avec des extrêmes d’un et de 76 jours. La morbimortalité globale était de 11, 52% avec 9, 96% de suppuration pariétale (n=51) et une mortalité de 1, 56% (n = 8) tous enregistrés parmi les cas de péritonite appendiculaire. Il existe une corrélation significative entre le type de complications et le délai d’admission (P=0, 00001).  Conclusion : Les appendicites compliquées sont fréquentes à l’HNN avec une morbimortalité importante. Le retard de la prise en charge constitue un facteur influencant la survenue des complications.   Objective: to report the results of the management of complicated appendicitis in adults at the National Hospital of Niamey (NHN). Patients and method: This was a retrospective, descriptive and analytical study over 10 years including all patients over the age of 15 who had been treated for complicated appendicitis at NHN. Results: during the study period, 8127 abdominal emergencies were recorded, of which 1837 were of appendicular origin, among them 512 were complicated appendicitis, i.e. 6.30% of abdominal emergencies and 27.87% of appendicitis. These were 337 (65.82%) men and 175 (34.18%) women; i.e. a sex ratio of 1.92. The mean age of the patients was 32.83 [±14.50] years with extremes of 16 and 90 years. The average admission time was 6 [±3.82] days with extremes of 1 and 14 days. Complicated appendicitis found was appendicular peritonitis in 74.02% of cases (n=379) followed by appendicular abscess in 21.48% of cases (n=110) and appendicular plastron in 4.5% (n= 23) cases. The treatment was operative in 95.5% of cases (n = 489). The approach used was the midline laparotomy in 81.05% of cases (n=415) and the appendix was gangrenous in 95.70% of cases (n=490) on exploration. The most performed procedure was appendectomy in 89.84% of cases (n = 460). The average duration of hospitalization was 9 [±10.61] days with extremes of one and 76 days. The overall morbidity and mortality was 11.52% with 9.96% parietal suppuration (n=51) and a mortality of 1.56% (n=8) all recorded among the cases of appendicular peritonitis. There is a significant correlation between the type of complications and the admission time (P=0.00001). Conclusion: Complicated appendicitis is common in NHN with significant morbidity and mortality. Delay in treatment is a factor influencing the occurrence of complications

Prise En Charge Des Victimes Du Conflit Armé Du Nord Mali Dans Les Hôpitaux De Niamey

Objectives: The aims of this study was to evaluate the management of lesions in victims of the malian conflict patients admitted to Niamey hospitals. Methods: A retrospective study was conducted in Niamey hospitals from January 1st, 2012 to December, 31th, 2013. Data collected included âge, sex, means of transport, topography of trauma, treatment and outcome. Results: The sample included fifty one (51) patients. All patients were male; the mean age was 29,5 years ± 9 years, ranging from 17-71 years. The age between 26 and 35 were most affected in 47% of cases (24 patients), soldiers represented 72.54% (37 patients); and civils 27.45% (14 patients). 74.50% of our patients (38) were been transported in Niamey by aircraft. The trauma concerned the members in 54.90% (28 cases), canio facial in 17.60% (9 cases), abdomen in 11.80% (6 cases). We observed only one polytrauma. 66.66% (34) of patients were injured by firearms, 29.41% (15) by accidents of roads, 3,93% by burn (2 patients). The lesions found were bone in 41.17% (21 patients), skin-muscle in 35.29% (18 patients), visceral in 9.80% (5 patients). Five patients died (9.80%). Conclusion: the internationalization of conflicts requires a reorganization of the care by involving all the nearness health structures in order to ensure adequate care and neutrality

Les Occlusions Intestinales Par Nœud Ileo-Sigmoïdien : Aspects Diagnostiques, Thérapeutiques Et Pronostiques

Introduction: Ileosigmoid knot (ISK), also known as compound volvulus or double volvulus, is a rare disease and affects mostly male subjects in their fourth decade. Delayed diagnosis often leads to complications with a high incidence of digestive necrosis. Materials and methods: This was a 10-year retrospective, descriptive and analytical study from 1 January 2007 to 31 December 2016, which covered all patients operated emergently for ISK in the surgical and surgical specialty departments at the Niamey National Hospital (NNH). Results: The series involved 8 cases of ISK, representing 0.82% of intestinal obstructions. There were 7 men and 1 woman. The average age of patients was 44.33 years with extremes ranging from 25 to 60 years. The main clinical signs were: abdominal pain (100%), inability to pass gas and stool (100%), vomiting (87.5%) and abdominal meteorism (87.5%). Four patients (50%) had a clear obstructive syndrome and the other 4 patients (50%) had associated signs of peritoneal irritation. Paraclinical diagnosis was difficult because of atypical clinico-radiological signs, but in all cases an abdominal x-ray was performed and showed a double loop of dilated sigmoid shadow in 87.5% of the cases. Laparotomy was the first approach used in all patients and led to a 50% necrosis rate. Hartmann’s colectomy and ideal colectomy were used in identical proportions, with 50% each. Ideal colectomy was characterized by a morbidity rate of 50% and a mortality rate of 25% compared to 0% for Hartmann’s procedure. The overall morbidity was 25% and the overall mortality was 12.5%. The average hospital stay was 65.87 days (range 17 to 128 days). The average time before reestablishment of digestive continuity was 50.37 days (range 31-128 days). Conclusion: Ileosigmoid knot is a rare condition at Niamey national hospital where the diagnostic approach is similar to that of occlusions in general, but remains difficult due to its uncommonness and atypical clinico-radiological signs. Necrosis rates and postoperative complications remain high

Implications of 36Cl exposure ages from Skye, northwest Scotland for the timing of ice stream deglaciation and deglacial ice dynamics

The French national AMS facility ASTER (CEREGE, Aix en Provence) is supported by the INSU/CNRS, the ANR through the "Projets thématiques d’excellence" program for the "Equipements d’excellence" ASTER-CEREGE action, IRD and CEA. The authors would like to thank Shasta Marrero for helpful and informative discussion on the CRONUScalc online calculator. DS was supported by a SAGES studentship and fieldwork by funds from the QRA and BSG.Geochronological constraints on the deglaciation of former marine based ice streams provide information on the rates and modes by which marine based ice sheets have responded to external forcing factors such as climate change. This paper presents new 36Cl cosmic ray exposure dating from boulders located on two moraines (Glen Brittle and Loch Scavaig) in southern Skye, northwest Scotland. Ages from the Glen Brittle moraines constrain deglaciation of a major marine terminating ice stream, the Barra-Donegal Ice Stream that drained the former British-Irish Ice Sheet, depending on choice of production method and scaling model this occurred 19.9 ± 1.5–17.6 ± 1.3 ka ago. We compare this timing of deglaciation to existing geochronological data and changes in a variety of potential forcing factors constrained through proxy records and numerical models to determine what deglaciation age is most consistent with existing evidence. Another small section of moraine, the Scavaig moraine, is traced offshore through multibeam swath-bathymetry and interpreted as delimiting a later stillstand/readvance stage following ice stream deglaciation. Additional cosmic ray exposure dating from the onshore portion of this moraine indicate that it was deposited 16.3 ± 1.3–15.2 ± 0.9 ka ago. When calculated using the most up-to-date scaling scheme this time of deposition is, within uncertainty, the same as the timing of a widely identified readvance, the Wester Ross Readvance, observed elsewhere in northwest Scotland. This extends the area over which this readvance has potentially occurred, reinforcing the view that it was climatically forced.PostprintPeer reviewe

Invagination Intestinale Aiguë De L’adulte: Aspects Diagnostiqsues, Thérapeutiques Et Étiologiques

Introduction: Acute intussusception is a rare clinical entity in adults where it accounts for only 1-2% of intestinal obstructions. The authors wanted to report cases of acute intussusception in adult patients, their diagnostic aspects, their management, and their etiologies. Patients and Methods: This study is a retrospective study of the medical files of patients of both sexes. They include adults over 15 years of age, operated between January 2010 and December 2014, who were diagnosed with obstruction due to acute intestinal intussusception. Results: Six cases of adult intestinal intussusception were collected. The average age was 26.5 years. The sex ratio was 1 and there were so many men as women. Five out of six patients were unstable on admission. The diagnosis was made preoperative in two cases out of six, 33.3%. Ultrasound revealed a target sign in two cases. The ileo-ileal form was the most frequent (5 cases out of 6) or 83.3%. Also, there were two cases of intestinal necrosis out of six. Intestinal resection was performed in five cases or 83.33%. The cause of intussusception was found in four cases out of six or 66.7%. Here, a tumor was the cause in half of the cases. Immediate surgical follow-up was uncomplicated in all patients. Conclusion: Acute intestinal intussusception of the adult is a very rare condition. The preoperative diagnosis of acute intussusception of the adult remains delicate. The ileo-ileal form is more frequent than the ileo-colic form in adults. Treatment is always surgical in adults