PURPOSE:The aim of this study was to describe the epidemiologic, diagnostic, and therapeutic aspects of surgical abdominal emergencies in a teaching hospital in a developing country (Togo).MATERIAL AND METHOD:This retrospective study included the medical files of all patients managed for surgical abdominal emergencies from March 1, 2002, to March 1, 2012.RESULTS:The study included 594 patients, with a mean age of 30.3 years (range: 1 month to 80 years) and a 2.1 male:female sex ratio. The emergencies were acute generalized peritonitis (54.5%), intestinal obstruction (26.6%), acute appendicitis (14.5%), and abdominal trauma (4.4%). Plain abdominal radiographs were taken for 414 patients with acute generalized peritonitis (324 cases) and intestinal obstructions without a strangulated hernia (90 cases). Nine patients had abdominal ultrasounds for abdominal trauma (5 cases) and appendicular abscess (4 cases). No abdominal CT scan was performed. All patients underwent surgery, 316 (53.2%) by physician assistants and 278 (46.8%) by surgeons. Resuscitation and anesthesia were performed by nurse-anesthetists. The postoperative course was complicated in 182 cases (30.7%). These complications included parietal suppurations (18.2%), eviscerations (5.1%), ileal fistulas (4.4%), and postoperative peritonitis (3%). The death rate was 11.4%.CONCLUSION:Surgical abdominal emergencies at the Kara teaching hospital were both common and serious. Their particularly high morbidity and mortality might be reduced through the adoption of reasonably practicable measures: paramedical personnel training, public awareness, establishment of management protocols, and improvement of technical equipment (laboratory).

UNLABELLED:The iatrogenal lesion of the inferior laryngeal nerve (ILN) during thyroid surgery is an incident, which can have greatest functional after-effects. Its research is recommended during cervicotomy for thyroidectomy and it can be easily found by the presence of Zuckerkandl tubercle, which is a postero-lateral excrescence of the thyroid gland.OBJECTIVES:The main objective of our study was the researching of the presence of this Zuckerkandl tubercle and appreciating the reports with the ILN.PATIENTS AND METHODS:From 1st October 2010 to 30th September 2012, we realized a continuous prospective study on a mono-operator series of 48 patients operated on for thyroidectomy. The Zuckerkandl tubercle has been researched from all the patients and classified according to the classification of Pelizzo et al.RESULTS:From 21 patients (43.75%), the Zuckerkandl tubercle has been well identified and it was grade 3 and grade 2. In those cases, the ILN was very closed to the tubercle. For the 27 other patients (56.25%), the tubercle was practically undetectable or reduced to a small glandular mound (grades 0 and 1). The connections with the nerve in this case were less evident.CONCLUSION:The zuckerkandl tubercle is comparatively frequent and is refound more than one time over 3 in our study. Its presence makes easier the identification of the ILN, which entertains a dangerous connection with the thyroid gland.

L’atteinte iatrogène du nerf laryngé inférieur (NLI) au cours de la chirurgie thyroïdienne est un incident grave qui peut avoir des séquelles fonctionnelles majeures. Sa recherche est recommandée au cours des cervicotomies pour thyroïdectomie et elle peut être facilitée par la présence du tubercule de Zuckerkandl, excroissance postéro-latérale de la glande thyroïde.

PURPOSETo evaluate the means for diagnosis and treatment of secondary hyperparathyroidism in patients with end-stage renal disease undergoing regular hemodialysis.METHODSThis prospective investigation studied patients with chronic renal kidney disease requiring and receiving hemodialysis at the Tokoin University Hospital in Lomé, from January 21, 2008, through December 31, 2008.RESULTSThe study population comprised 42 patients: 24 men and 18 women ranging in age from 20-82 years (mean: 42.62 years). Hyperparathormonemia was found in 20 of 24 patients for whom parathormonemia was assayed. Two patients with hyperthyroidism received a phosphorus chelator, and another went to Egypt for renal transplantation. The various other treatments we applied were not efficacious. We noted three cases of pathological fractures and one case of sudden death.CONCLUSIONThe risk of parathyroidism in patients receiving hemodialysis is unavoidable. Its course is marked by a risk of sudden death due to the cardiovascular damage it causes. Numerous factors impede its effective management in Togo.

Objective. - To appreciate and to analyse the different human and materials capacities available for management in view of its total eradication.Patients and methods. - From January 2001 to December 2005, a census of obstetrical urogenital fistulae was carried out from treatment cases notes in all the hospitals of Togo. It was a retrospective and descriptive study which included the age of the patients, the situation of the sanitary institution, the quality of the physician in charge of the obstetrical fistulae, information about the kind of the fistulae, the way in which the delivery was done and the financial incidence for the repair of the fistulae. The subject of the study, the confidentiality on the contents of the case notes and the results expected were clarified to the responders.Results. - One hundred and sixty-three (163) cases of obstetrical fistulae were studied. The average age was 21 years (extremes: 15 and 45). Forty-four sanitary institutions comprising 93 treatments service were visited. Hospitals were noted to be far away from patients in the north of the country. All the four hospitals able to take care of obstetrical fistulae effectively were located in the south. Eight hundred and forty health personals were questioned and 467 (55.60%) had said to be able to make the diagnosis of obstetrical fistula. A maximum of four surgeons were trained and competent to manage obstetrical fistula. Operating equipment of obstetrical fistula was inexistent in 40 hospitals, that is 90.90%.Conclusion. - Obstetrical fistula is present in Togo and represents a public health problem to eradicate. It is more frequent in young women from rural areas and of tow educational level. It constitutes also a handicap for the reproduction of humankind. (C) 2009 Elsevier Masson SAS. All rights reserved.

We performed a retrospective study on 348 files of patients hospitalised for closed thoracic trauma during 10 years (1990-1999). The objective was the evaluation of its management. 278 men (79.9%) and 70 women (20.1%) were concerned (sex ratio = 4) and the mean age was 35.7 years. Road accidents were the first etiology (73.56%). Pulmonary contusion in 170 patients (48.85%) was the most frequent thoracic injury followed by 154 (44.25%) cases of rib fractures, 72 (20.70%) cases of hemothorax and 49 (14.08%) cases of pneumothorax. 53 (15.23%) chest tube were placed. 4 thoracotomy and one sternotomy were performed. Death occurred in 27 (7.76%) cases and was mainly related to the presence of associated injuries. X ray remains useful. An improvement of survival needs creation of a department of thoracic surgery. Nous avons retrospectivement analyse 348 dossiers de traumatismes fermes du thorax recenses sur 10 ans (1990 -1999). Le but de notre travail etait d’en analyser la prise en charge. Les 348 patients se repartissaient en 278 hommes (79,9%) et 70 femmes (20,1%) avec une sex-ratio de 4. L'âge moyen etait de 35,7 ans. Les accidents de la voie publique ont constitue la premiere etiologie (73,56%). Les lesions thoraciques etaient dominees par les contusions pulmonaires (48,85%), suivies des fractures de cotes (44,25%), puis de 72 cas (20,70%) d'hemothorax et de 49 cas (14,08%) de pneumothorax ; 53 drains (15,23%) ont ete places. Quatre thoracotomies et une sternotomie ont ete realisees. 27 deces furent enregistres (7,76%), en rapport surtout avec les lesions associees extrathoraciques. La radiographie standard reste utile. Une amelioration de la survie passe par l’installation d’un service de chirurgie thoracique.