Devenir post-opératoire des ostéotomies tibiales hautes pour gonarthroses désaxées et avancées: Postoperative outcome of high tibial osteotomies for offaxis and advanced osteoarthritis

Context and objective. Despite being recognized as an alternative to total or unicompartimental prothesis in the treatment of offset and advanced femoro-tibial knee osteoarthritis, data about high tibial osteotomy (HTO) are paradoxically scarce in sub-Saharan Africa. This study aimed to describe the postoperative functional outcome of HTO. Methods. Thirty-one consecutive patients with advanced knee osteoarthritis (in valgus or varus), underwent HTO, using the Blaimont technique slightly modified by Clemens between 1998 and 2011, in three hospitals in Kinshasa. A retrospective assessment of the cases was done, based on the International Knee Society (IKS) score before and after the HTO. Results. After HTO, the IKS score was 78 points. The mechanical axis was 180° degrees (171 to 185°). After the surgery all the patients were able to squat, to sit with knees bent at 90°, and to move on a suitable distance compared to the preoperative perimeter. Neither rotational instability, nor mechanical discord were observed, but rather a case of misplacement of the spindle and two other cases of cutaneous necrosis. Conclusion. These results showing a functional improvement of the pain and the mobility in patients after HTO highlight the position of this technique as an effective alternative to of the TKA or UCP in the management of knee osteoarthritis. Contexte et objectif. Bien que l’ostéotomie tibiale haute de recentrage (OTH) dans le traitement des gonarthroses fémoro-tibiale désaxées et avancées soit reconnue comme alternative aux prothèses totales ou unicompartimentales, les données y relatives sont paradoxalement inexistantes en Afrique subsaharienne. L’objectif de la présente étude a été de décrire le devenir fonctionnel post opérative de l’OTH. Méthodes. Nous avons rétrospectivement examiné le devenir de trente et un patients consécutifs opérés par OTH pour gonarthroses avancées (en valgus ou en varus) entre 1998 et 2011, dans 3 formations hospitalières de Kinshasa, par une même équipe. Le recul était de 6,5 ans (maximum de 9 ans). Ils ont été tous opérés, selon la technique décrite par Blaimont et légèrement modifiée par Clemens. L’évaluation a été faite à l’aide du score international Knee society (IKS) avant et après OTH. Après l’intervention, 86,8% des patients étaient satisfaits ou très satisfaits. Résultats. Après OTH, le score IKS genou était de 78 points, le score IKS fonction était de 76 points. L’axe mécanique moyen était à 180 degré (de 171 à 185 degré). Les patients opérés étaient capables de s’accroupir, de s’asseoir les genoux fléchis à 90 de grés (100%), de se mettre en position à genoux et de se déplacer sur une distance confortable par rapport au périmètre de marche préopératoire (100%). Il n’y a eu aucun cas d’instabilité rotatoire ni de descellement mécanique mais plutôt un cas de mal positionnement de la broche et deux autres cas de nécrose cutanée. Conclusion. Ces résultats montrant une amélioration fonctionnelle de la douleur et de la mobilité des patients avec gonarthrose opérés, confirment que l’OTH est une alternative efficace des PTG ou des PUC dans la prise en charge des gonarthroses. &nbsp

Une torsion de rate baladeuse révélée par un syndrome subocclusif intestinal : observation clinique: Wandering spleen torsion revealed by an acute abdomen: a case report

Wandering spleen is a rare condition brought about through laxity or absence of intraperitoneal ligaments. At 5 years old, a child was admitted in emergency for three-day history of abdominal colic, fever, bloated abdominal without stop of stool or gas. Clinical examen and sonography show ectopic spleen. Chirurgical intervention revealed wandering spleen torsion treated by splenectomy. Authors reported a rare case of spleen malformation complicated by torsion revealed by bowel subocclusion with complete resolution of symptoms after splenectomy. La rate baladeuse est une malformation rare due à une hyperlaxité ou à une agénésie des ligaments suspenseurs de la rate, relevant d'une anomalie congénitale ou acquise. A 5 ans, une fillette était admise pour une courte histoire de coliques abdominales, fièvre, ballonnement abdominal sans arrêt des matières et gaz. L’examen clinique et l’échographie abdominale ont montré une rate ectopique (flanc droit). L’intervention chirurgicale réalisée a montré une torsion splénique sur rate baladeuse traitée par une splénectomie. Les auteurs présentent ce cas inhabituel de malformation splénique compliquée de torsion revélée par un syndrome subocclusif intestinal opéré d’évolution favorable

Response to treatment in a prospective cohort of patients with large ulcerated lesions suspected to be Buruli Ulcer (Mycobacterium ulcerans disease)

BACKGROUND: The World Health Organization (WHO) advises treatment of Mycobacterium ulcerans disease, also called "Buruli ulcer" (BU), with a combination of the antibiotics rifampicin and streptomycin (R+S), whether followed by surgery or not. In endemic areas, a clinical case definition is recommended. We evaluated the effectiveness of this strategy in a series of patients with large ulcers of > or =10 cm in longest diameter in a rural health zone of the Democratic Republic of Congo (DRC). METHODS: A cohort of 92 patients with large ulcerated lesions suspected to be BU was enrolled between October 2006 and September 2007 and treated according to WHO recommendations. The following microbiologic data were obtained: Ziehl-Neelsen (ZN) stained smear, culture and PCR. Histopathology was performed on a sub-sample. Directly observed treatment with R+S was administered daily for 12 weeks and surgery was performed after 4 weeks. Patients were followed up for two years after treatment. FINDINGS: Out of 92 treated patients, 61 tested positive for M. ulcerans by PCR. PCR negative patients had better clinical improvement than PCR positive patients after 4 weeks of antibiotics (54.8% versus 14.8%). For PCR positive patients, the outcome after 4 weeks of antibiotic treatment was related to the ZN positivity at the start. Deterioration of the ulcers was observed in 87.8% (36/41) of the ZN positive and in 12.2% (5/41) of the ZN negative patients. Deterioration due to paradoxical reaction seemed unlikely. After surgery and an additional 8 weeks of antibiotics, 98.4% of PCR positive patients and 83.3% of PCR negative patients were considered cured. The overall recurrence rate was very low (1.1%). INTERPRETATION: Positive predictive value of the WHO clinical case definition was low. Low relapse rate confirms the efficacy of antibiotics. However, the need for and the best time for surgery for large Buruli ulcers requires clarification. We recommend confirmation by ZN stain at the rural health centers, since surgical intervention without delay may be necessary on the ZN positive cases to avoid progression of the disease. PCR negative patients were most likely not BU cases. Correct diagnosis and specific management of these non-BU ulcers cases are urgently needed.This study was supported by the Directorate-General for Development and Cooperation (DGDC), Brussels, Belgium, the European Commission (International Science and Technology Cooperation Development Program) (project no. INCO-CT-2005-051476-BURULICO), and by a grant from the Health Services of Fundacao Calouste Gulbenkian. K.K. was supported by a grant from DGDC. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript