Valeur diagnostique de la tomodensitométrie dans la cysticercose cérébrale à Lomé

La cysticercose a une prévalence élevée dans les pays sub-sahariens et son diagnostic reste difficile. Cette étude a pour but de déterminer la valeur diagnostique de la tomodensitométrie dans la cysticercose  cérébrale. Recrutement des patients ayant bénéficié d'une  tomodensitométrie cérébrale dans l'une des circonstances suivantes: épilepsie, hypertension intracrânienne, syndrome pyramidal, détérioration mentale, ataxie locomotrice ou une diminution de l'acuité visuelle. Les critères de Del Brutto et al. avaient permis de retenir le diagnostic positif de cysticercose cérébrale. Pendant la période, 4193 patients avaient été inclus à l'étude, dont 140 cas de cysticercose cérébrale (3,3%). L'âge moyen des patients de cysticercose cérébrale était de 36 ± 14 ans, avec des extrêmes de 17 ans et 59 ans. La sensibilité et la spécificité de la tomodensitométrie dans la cysticercose cérébrale sont respectivement de 96,4% et 98,3%. La valeur prédictive positive et la valeur prédictive  négative de la tomodensitométrie sont respectivement de 65,9% et  99,8%. Les aspects  tomodensitométriques chez les vrais positifs sont dominés par des lésions associées, 72 cas (53,3%), suivies d'une hypodensité nodulaire arrondie unique ou multiple sans prise de contraste iodée, 17cas (12,6%). La TDM est une technique d'imagerie qui a une sensibilité et une spécificité élevées dans le diagnostic de la cysticercose cérébrale. Cependant, les autres critères de diagnostic restent utiles du fait de l'existence de nombreux cas de faux positifs à la tomodensitométrie

Revue Des Doses d’Exposition Et Des Methode d’Optimisation En Tomodensitometrie (TDM) De l’Enfant Au Togo

Objectives: To assess the justification of indications of CT scans and the exposure doses of children during CT scans. Methods: Prospective study of 104 CT-sans of children collected over a period of 6 months. Results: Female children were predominant with a sex ratio female / male of 1.2. The predominant age group was the 10 to 15 years (41%). The CT-Scan of the head was the most practiced exam, with 64.42% (67/104). When analyzing information according to the recommendations of the Guide of well practices of French Society of Radiology (SFR) and the French Society of Biophysics and Nuclear Medicine (SFBMN), only 77% of CT-Scans were justified. Almost half (49.04%) of CT-Scans had a CT-Dose Index (CTDI) and Dose Length Product (DLP) greater than the French reference norms defined for each group of age. The average values of CTDI and DLP are above the norms for all CT-scans of the skull, facial bones and sinuses. Conclusion: The doses administered to children by CT-Scans are above accepted norms. Improved practices continue medical training of radiology manipulators and the creation of a regulatory or an agency of radioprotection is necessary

Contribution of ultrasonography to the diagnosis of internal bleeding in snakebite envenomation

Background: In Africa, snakebite envenomations are frequently complicated by life-threatening hemorrhagic syndromes. The authors of the present study conducted a prospective analysis at the University Hospital of Parakou (north of Benin) for seven months (January 1 to July 31, 2014) to assess the contribution of ultrasonography to the diagnosis of internal bleedings and management of envenomation. Methods: An ultrasound examination was performed in all patients with clinical envenomation regardless of its severity. The study involved 32 patients admitted to the ICU of the University Hospital of Parakou. Results: The average age was 27 +/- 13.9 years. The main signs of severity were: prolongation of clotting time (88 %), severe anemia (41 %), clinical hemorrhage (47 %), and shock (19 %). The ultrasound imaging showed internal hemorrhage in 18 patients (56 %). There were hematomas (22 %), hemoperitoneum (13 %) or a combination of both (22 %). The occurrence of internal bleeding and hemoperitoneum were mainly related to the delay of hospital presentation (p = 0.007) and the existence of external bleeding (p = 0.04). Thirty patients (94 %) received antivenom. Case fatality rate was 3.1 %. Conclusion: Ultrasonography may help in diagnosing internal bleeding, even in patients that did not show external hemorrhages, and evaluating its importance. As a consequence, the management of snakebite victims may be significantly improved

Echographie Pédiatrique En Pratique Hospitaliere Au Centre Hospitalier Universitaire (CHU) De Kara Au Togo

Purpose: To list pediatric ultrasound exams performed at Kara University Hospital Center in Togo and the pathologies observed. Materials and methods: This was a retrospective and descriptive study of the results of pediatric ultrasound examinations performed in the Department of Radiology and Imaging of Kara University Hospital Center. The study ran from January 1, 2013 to December 31, 2016, over a period of 3 years. Results: The frequency of pediatric ultrasounds was 5.1%. The average age of the patients was 2.16 years with extremes of 1 day to 15 years. There was a male predominance with a sex ratio of 1.4. Abdomino-pelvic ultrasound were the most represented, 92%, followed by cervical ultrasound in 2.6% of cases. Abdominal ultrasound indications were dominated by abdominal pain in 33.6% of cases, followed by palpation of abdominal mass in 15.7%. Cervical ultrasounds were motivated in 5 out of 8 cases by the cervical swelling. Abdomino-pelvic ultrasonography was pathological in 70.1% of cases. Hepatic affections were the most common abdominal abnormality in 37.8% of cases followed by splenic disorders. Hepatic lesions were dominated by European Scientific Journal February 2018 edition Vol.14, No.6 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431 444 homogeneous hepatomegaly with 63.2% of cases. Cervical ultrasound was pathological in 6 out of 8 cases. The lesions observed were mainly cervical lymphadenopathy (4 cases out of 6). Conclusion: Ultrasound is a very useful tool in the exploration of pediatric diseases. The abdominal ultrasound is the most performed and hepatic pathologies are the most common

Connaissances Et Motivations Des Medecins Dans La Prescription Des Examens D’imagerie Devant Une Urgence Abdominale Non Traumatique Au Togo: A Propos D’une Enquete Realisee Aupres Des Medecins

Objective: To evaluate physicians' knowledge of prescribing imaging modalities in non-traumatic abdominal emergencies. Materials and method: A transversal and analytical study, consisting of the filling of a questionnaire distributed to general physicians. The survey card included, among others, the first-line imaging modality and the most effective on four abdominal emergencies found in Togo. Results: Regarding acute appendicitis, 73% of physicians estimated the imaging needed. For 92%, ultrasound was the firstline imaging technique because of its availability according to 40%. For 87%, the scan was the most effective exam. In peritonitis, 69% of physicians considered imaging important. For 98% Conventional Chest and Abdominal Radiography was the first-line examination because 52% of physicians said it was the most available. 89% thought the CT scan was the most effective. In the case of bowel obstruction, 89% of physicians found the necessary imaging. For 96%, the first-line examination was the Conventional Chest and Abdominal Radiography because of its availability according to 51% of doctors. All physicians felt that the CT scan was the most effective examination. Concerning acute cholecystitis, 95% considered imaging very important. For 95%, ultrasound was the first-line examination. Its prescription was motivated by its availability according to 50% of doctors. 96% felt that CT was the most effective examination. Conclusion: From our study, it appears that in abdominal emergencies, imaging examinations necessary for diagnosis are prescribed according to their availability and cost, not according to their effectiveness

Echographie Doppler Arterielle Testiculaire Dans L’infertilite Masculine A Lome

Objective: Determine the relationship between the testicular arterial resistance index (IR) and spermatogenesis. Material and method: prospective analytical study over a period of 12 months at CHU campus and National Institute of Hygiene of Lomé. The parameters studied were anomalies of sperm count, sperm volume, testis volume, and resistance index (RI). The study of the correlation between our variables was done using the Chi square test (χ2). Results: The mean age of men was 36.26 years. Sperm volume was normal in 73% men and abnormal in 27% men. 65% had normal sperm counts, and 35% had abnormal sperm counts. The normal testicular volume was found in 42% men and 58% had an abnormal testicular volume (hypotrophic testis). 51% men had the pathological RI while 49% had a normal RI. There was no statistically significant relationship between testicular volume and sperm count. Also, no statistically significant relationship between RI and testicular volume. But, there was a statistically significant correlation between RI and sperm count. No statistically significant difference between RI and sperm volume. Conclusion: RI can be used with sperm analysis and hormonal studies as part of the clinical evaluation of infertile men. An intratesticular RI greater than 0.6 is associated with decreased total motile sperm

Revue Des Doses D’exposition Et De La Justification Des Radiographies Standard En Pratique Pédiatrique Au Togo

Aims: To assess the justification of indications and exposure doses to children during radiographics. Methods: Prospective study of 102 X-ray exams of children collected over a period of 6 months in the Department of Radiology of Kara Teaching Hospital. Objectives: To assess the rationale guidance and exposure doses to children when standard radiographic examinations. Methodology: prospective observational study of 102 standard radiographs (Rx) collected in the radiology department of the University Hospital of Kara on a 6 month period. Results: Male children were predominant with a sex ratio boy / girl of 1.3. The predominant age group was the 5 to 10 years. Chest X-rays were the most practiced exam, with 43%. According to the Guide of well practices of French Society of Radiology (SFR) and the French Society of Biophysics and Nuclear Medicine (SFBMN), 80% of exams were justified. The comparison of our results to diagnostic reference levels (DRLs) shows that 43% and 39% of standard X-rays had dosimetric values exceeds the RDLs respectively the entrance Dose (De) and Dose Surface Product (DSP). Conclusion:Our study reveals that compliance guidance assessments to the proper use of medical imaging examinations guide was not always effective but satisfactory. The study dosimetric constants showed that the dose to children exceeded in a large proportion of the French and Belgian DRLs

Hematome Extra Dural (HED) cervical post traumatique revelateur d’un trouble de l’hemostase

L’hématome extradural ou l’hématome épidural post traumatique du rachis cervical est une affection rare comprimant la moelle. Nous en rapportons un cas ayant révélé un trouble de l’hémostase chez un patient de 40 ans sous antivitamine-K1. La TDM avait permis de faire le diagnostic. L’évolution était favorable, sans intervention chirurgicale, avec résolution des signes neurologiques trois jours après le traumatisme.Mots clés: Hématome extra dural, traumatisme, trouble de l’hémostase, rachis cervicalEnglish Title: Post traumatic cervical epidural hematoma revelating hemostasis disorderEnglsh AbstractExtra dural hematoma or epidural post traumatic hematoma of the cervical rachis is a rare affection witch causes a severe spinal cord compression. We report a case having revealed a hemostasis disorder at a 40-year-old patient under antivitamin K. CT-scan had allowed doing diagnosis. The evolution was favorable, without surgery, with resolution of neurological signs three days after the traumaKeywords: Epidural hematoma, traumatism, hemostasis disorder, cervical rachi

Echographie devant une metrorragie du premier trimestre de grossesse sur uterus bicorne a issue favorable.

Nous rapportons un cas de grossesse dans un utérus bicorne, avec un épisode de saignement vaginal durant le premier trimestre. L'échographie a été capable de trouver un épaississement de l'endomètre de la corne utérine vide qui pourrait expliquer cette métrorragie.Mots clés : Utérus bicorne, métrorragie, premier trimestre, échographie

Profil clinique et radiographiques des spondylolisthesis lombaire chez l’adulte a Lome : a propos de 193 cas

Objectifs: Faire le diagnostic de spondylolisthésis, et apprécier son retentissement clinique selon le stade d’évolution.Méthodologie: Etude prospective d’un an, portant sur 193 cas de spondylolisthésis chez les adultes de plus de 18 ans, ayant bénéficiés d’une radiographie standard du rachis lombaire.Résultats: La fréquence était de 9,93%. La moyenne d’âge était de 31ans pour le spondylolisthésis par lyse isthmique et de 57 ans pour le spondylolisthésis dégénératif. Le sexe masculin (55,84%) était le plus représenté. Le spondylolisthésis secondaire à une lyse isthmique (46,11%) et le spondylolisthésis dégénératif (53,89%) étaient les principales étiologies retrouvées. Les conducteurs étaient les plus concernés avec 32,33% suivi des cultivateurs et des menuisiers avec respectivement 14,21% et 12,77%. L’étage L4-L5 était le plus touché dans le spondylolisthésis dégénératif. Dans le spondylolisthésis par lyse isthmique l’étage L5-S1 était le plus concerné. Le maitre symptôme était la lomboradiculalgie. Elle était notée à tous les stades du spondylolisthésis. La lombalgie commune était seulement notée au stade I. Le traitement a été conservateur.Conclusion: Le spondylolisthésis, qu’il soit dégénératif ou par lyse isthmique est responsable de manifestations cliniques parfois invalidantes.Mots clés: Spondylolisthésis- radiographie standard - lomboradiculalgieEnglish Title: Clinical and radiographic profile of lumbar spondylolisthesis in adults in Lome: about 193 casesEnglish AbstractObjectives: make the diagnosis of a spondylolisthesis, and estimate (appreciate) its clinical expression.Method: It was a prospective study of one year, concerning 193 cases of spondylolisthesis at the adults of more than 18 years old.Results: the frequency was 9.93%. Isthmic spondylolisthesis (52.79%) and the degenerate spondylolisthésis (47.21%) were the main types of spondylolisthesis found. The mean age was 31 years old for the isthmic spondylolisthesis, and 57 years old for the degenerate spondylolisthesis. The male (55.84%) was the most represented. The drivers were the most concerned with 32.33%, followed by the farmers and the joiners with respectively 14.21% and 12.77%. Degenerate spondylolisthesis was most found in L4-L5. In the isthmic spondylolisthesis, L5-S1 was the most concerned. The common symptom was the radicular pain. It was noted in all the stages of the spondylolisthesis. The lumbago was only noted at the stage I. Treatment was often medical.Conclusion: spondylolisthesis is responsible of radicular pain. Radiography make diagnosis.Keywords: Spondylolisthésis, radiography, radicular pai