The occurrence of deep vein thrombosis during pregnancy is a rare situation with an incidence of 0.6 to 1 per 1000 pregnancies. This situation leads to diagnostic and especially, therapeutic difficulties; its occurrence in the first trimester, especially in a woman from disadvantaged backgrounds, is an additional therapeutic challenge. We report a case of deep vein thrombosis of the lower limb in a pregnancy at 6 weeks' gestation in a 26-year-old pregnant woman, a primigravida with one living child. The diagnosis has been suspected on the basis of clinical signs and D- dimer test, and confirmed by venous Doppler ultrasound. The initial treatment has been mainly based on anticoagulation with anti k-vitamin (warfarin sodium), with an effective dose, throughout the pregnancy. The enoxaparin at a therapeutic dose initially introduced was interrupted for financial reasons, forcing the medical team to introduce AVK with the informed consent of the patient and her family, giving priority to the mother to ensure continued care in these conditions. The mode of delivery was vaginal and the maternal prognosis was good with normal postpartum period. The fetal prognosis was also good with the birth of a healthy newborn.

Fibrosarcoma is defined by the World Health Organization (WHO) as a malignant tumour, characterized by the presence of intertwined bundles of collagen fibers, and by the absence of other types of histological structures, such as bone or cartilage. In this article, we describe the observation of a case of disabling giant fibrosarcoma at the shoulder girdle in order to highlight the clinical, Para clinical and therapeutic particularities. This is a 58-year-old male patient with a history of apparently good health. He reports that for 18 years he has had a pimple on his shoulder that has been growing until it reaches its current very large size and causing him a disability. After an unremarkable blood test, the patient was surgically treated by performing a wide excision with a good surgical margin and skin grafting. The surgical specimen weighed 3700 g. The patient was regularly followed up for 4 years without recurrence. Soft tissue sarcomas are a heterogeneous group of tumours that are not very common and histologically diverse, including fibrosarcoma, and whose treatment results in a wide surgical resection with free margins. Skin grafting provides a very satisfactory result face to huge generated loss of tissues while removing the handicap in patients with giant tumours in our resource-limited countries.

Non-melanocytic skin cancers, which include basal cell carcinomas (basaliomes) and squamous cell carcinomas (squamous cells), are the most frequent neoplasms in populations with fair skin. Squamous cell carcinoma also called squamous cell carcinoma or squamous cell carcinoma; is a malignant skin neoplasia, derived from cells of the epidermis or its appendages; of rapid growth, which can metastasize to regional lymph nodes and other organs. The treatment of facial lesions is eminently surgical. Although there are a wide variety of surgical techniques to reconstruct skin coverage, in some cases the reconstruction of defects produced by the removal of facial malignancies presents a real challenge for the surgeon. The main goal of surgical treatment of skin tumours is the absence of recurrence, whether local or distant. We report 4 cases of squamous cell carcinoma in the face with satisfactory results and without recurrence. In most cases (three), we used one or more advancement flaps and the nasolabial flap in one case.

Introduction: The sequelae of burns induce variable functional, aesthetic and psychological repercussions. They can be minor or major. The sequelae of burns are basically attributable to two causes: the male therapy conducted and the severity of the burn itself. Objective: To describe the clinical and epidemiological characteristics of burn sequelae in the "young" Dermatology Hospital of Bamako in Mali. Methodology: A descriptive and transversal study carried up on patients with burns sequelae and operated in Dermatological hospital of Bamako at the plastic and oncological service from January 2017 to December 2020. The study population consisted of all the patients (138 cases) with burns sequelae. Result: The sex ratio was 1.06. The mean age was 13.73 years (range: 7 months to 74 years). The most affected age group was paediatric with 65.90% of cases and the dominant age group was 0 to 5 years old with 41.3%. Hot liquid was the most frequently found causative agent at 52.9%, followed by fire and hot metal at 31.2% and 8%, respectively. Flanges were the most dominant (56.80%), followed by cupboards (33.73%) and ulcers on old burns (4.73%). Conclusion: A well-conducted therapy would not only reduce the severity of burn sequelae but also avoid them, which would allow empowering patients after burns and reducing the high costs associated with the management of these sequelae.

Penile cancer is a rare pathology. Squamous cell carcinoma represents the most common histological type. Radical excision surgery, although often mutilating, remains the best treatment for localized stages. We retrospectively report the epidemiological, clinical, therapeutic and progressive characteristics of two clinical cases of penile cancer.

Summary: Introduction: Sexual violence is an all-encompassing term that refers to "any sexual act, attempt to obtain a sexual act, comment or advance of a sexual nature directed against a person's sexuality using coercion" according to the WHO. Objective: Study sexual violence based on gender at the level of the care unit << One Stop Center >> the Reference Health Center of Commune V of the District of Bamako. Materials and Methods: This was a descriptive and analytical cross-sectional retrospective study from January 1, 2019 to December 31, 2020. We included in this study, all survivors of sexual violence at least 10 years old admitted to the "One Stop Center" care unit of the Reference Health Center of Commune V of the District of Bamako. Results: The prevalence of sexual violence was 54.62% in relation to all cases of gender-based violence and 3.36% in relation to all gynaecological emergencies. The age group less than or equal to 19 years accounted for 54.18% of survivors, 69.68% of survivors were single. In 39.95% of the cases the incident took place in the home of the alleged perpetrator of the sexual assault. The survivors had presented a state of fear and panic in 23.92% of cases. Penetration was << penis-vagina >> in 37.1% of survivors. Survivors received psychiatric assistance in 12.87% of cases. Conclusion: Sexual violence is relatively common in our care unit << One Stop Center >>. They had constituted the majority of cases of gender-based violence. The care was holistic.

Introduction: Active Management of the Third Stage of Labor (AMTSL) consists of a range of interventions aimed at facilitating placental expulsion by increasing uterine contractions and preventing postpartum hemorrhage (PPH) by avoiding uterine atony. Its usual components include uterotonics administration, controlled cord traction, and uterine massage after placental expulsion [1]. The objective of this study was to assess the practice of Active Management of the Third Stage of Labor (AMTSL) among parturients at the Sibiribougou Community Health Center (CS Com). Methodology: This was a descriptive cross-sectional study conducted at the Sibiribougou CS Com from October 11th to November 11th, 2022, for a period of 1 month. The study population consisted of all women in labor and the healthcare providers involved in their care. A total of 101 parturients and 17 healthcare providers were included. Results: The age group of 20 to 30 years was the most represented among parturients, accounting for 54.5% of cases. The mean age was 23.17 years, with a standard deviation of 4.33 years and ranging from 17 to 35 years. The majority of women were married, accounting for 95.05% of cases. Most women were pauciparous, accounting for 55.4% of cases. In 100% of cases, oxytocin was administered within a minute after fetal expulsion, and 75% of injections were correctly performed according to AMTSL standards. Controlled cord traction was performed in 96.3% (97) of cases. It's worth noting that out of the 97 cases, this exercise was done correctly in 67.1% of cases, which corresponds to 65 parturients. In most cases, uterine massage was performed immediately, accounting for 85.1% of cases. In conclusion, the practice of AMTSL is systematic in the delivery room of the CS Com. However, the quality of AMTSL practice remains insufficient, as among the assessed steps, only oxytocin administration was performed in all cases, and only 75% of these were done correctly.

Introduction: Darier and Ferrant dermatofibrosarcoma is a rare malignant cutaneous mesenchymal tumour, representing less than 0.1% of malignant tumours and less than 5% of soft tissue sarcomas in adults. The aim of this study was to describe the evolutionary profile of cases of dermato fibrosarcoma of Darier et Ferrant reported in the dermato-venereology department of the National Centre for Disease Control (CNAM). Patients and methods: This was a descriptive cross-sectional study conducted in the dermatology department of the National Centre for Disease Control Support between 1991 and 2016, a period of 25 years. Was included, all patient with a histologically confirmed dermatofibrosarcoma notified in the registers of the CNAM histology laboratory or in the patient's medical file during the study period. Results: In total we collected 23 cases out of 5520 biopsied patients, i.e. a proportion of 0.41%. Males represented 60.8% with an average age of 40 years. The lesions were simple nodular in 12 of the 23 patients (52.2%), multi-nodular in 7 of the 23 patients (30.4%), nodulo-ulcerous and in patches in 4 of the 23 patients (17.4%). The lesions were located on the trunk in 60.8% of cases (image 1), on the head in 21.7% of cases and on the limbs in 17.5% of cases. The mean size of the lesions was 10×8cm with extremes of 3cm×3cm to 25cm×20cm. Management was exclusively surgical. Conclusion: DFSP is a rare tumour with a slow evolution, characterised by its rare metastasis but above all by its strong tendency to recurrence. The diagnosis is often evoked clinically and confirmed by histological study. The treatment of DFSP is surgical based on a large and deep lesion removal. Clinical monitoring allows early detection of recurrence, which is frequent in this disease.

La varicelle est une maladie infectieuse bénigne, contagieuse et immunisante due au virus varicelle zona de la famille des alpha-herpes viridae. Ses complications sont graves, parfois létales en raison des atteintes multiviscérales. Nous rapportons 3 cas. Cas 1 : il s’agissait d’un homme de 26 ans, sans antécédent, adressé pour détresse respiratoire. Il était traité par dexaméthasone inj. et anti-H1. À l’examen, on notait des lésions typiques de varicelle, des râles ronflants bilatéraux et une orchi-épididymite. La sérologie VIH était négative. Le cytodiagnostic de Tzanck (CT) trouvait des cellules ballonisantes. La radiographie des poumons objectivait des opacités micronodulaires diffuses. Un traitement par aciclovir 10 mg/kg/8 h entraînait une amélioration rapide. Le patient sortait guéri après 3 semaines d’hospitalisation. Cas 2 : une femme de 20 ans, sans antécédent, était adressée pour toux productive non améliorée sous mucomyst, loratadine, ibuprofene, érythromycine. On notait deux cas de varicelle dans la famille. Elle présentait des lésions cutanées typiques. L’auscultation pulmonaire retrouvait des râles crépitants diffus bilatéraux. Le diagnostic de pneumopathie varicelleuse était évoqué. La patiente décédait moins de 10 heures après son admission dans un tableau de détresse respiratoire. Cas 3 : un homme de 36 ans, sans antécédent, consultait pour éruption cutanée fébrile. Il recevait, par voie orale, bêtaméthasone, antibiotique, tramadol, desloratadine, puis par voie injectable méthylprednisolone et aspégic. À l’examen clinique, il présentait des lésions typiques de la varicelle. L’examen neurologique notait une para parésie avec abolition des réflexes ostéotendineux (syndrome de Guillain-Barré). Le bilan biologique mettait en évidence une hyperleucocytose, une élévation des transaminases, une sérologie HIV négative. Le CT retrouvait des cellules ballonisantes. La radiographie thoracique révélait des opacités nodulaires bilatérales. Un traitement par aciclovir 10 mg/kg/8 h avec arrêt de la corticothérapie était instauré. Le lendemain un syndrome hémorragique s’installait et le patient décédait en 24 h. Nous rapportons 3 cas de complications aiguës de la varicelle chez l’adulte. La pneumonie varicelleuse retrouvée chez nos malades (cas 1 et 2) est la plus fréquente des complications graves de la varicelle chez l’adulte ; son incidence est estimée de 16 à 33 % avec une mortalité pouvant atteindre 20 %. Plusieurs facteurs ont été associés au développement de l’atteinte pulmonaire dans la varicelle. Le syndrome de Guillain-Barré évoqué (cas 3) a pu être induit par l’infection virale. Ce syndrome peut induire des difficultés respiratoires pouvant être fatales chez le patient. Dans cette observation, le décès est probablement lié à un déficit en protéine C ou thrombophilie par mutation du facteur V qui favorise la survenue de lésions purpuriques. Outre leur âge, nos patients présentaient deux facteurs de gravité : (i) dans le cas 2, Il s’agissait de la troisième personne atteinte successivement par la maladie dans la famille. Il semble, en effet, qu’en cas de varicelle intrafamiliale, les cas secondaires soient plus sévères que les cas primaires ; (ii) pour les trois cas, les traitements par stéroïdes ou AINS de leur virose. La conférence de consensus en thérapeutique anti-infectieuse recommande l’utilisation d’acyclovir par voie intraveineuse (10 mg/kg tous les huit heures) dans la varicelle compliquée du sujet adulte, en particulier la pneumopathie varicelleuse pendant une durée de sept à dix jours. Ce traitement a été efficace dans le cas 1. Ces observations soulèvent la question de la méconnaissance des premiers signes de la varicelle, responsable de la prescription de molécules délétères. Nous attirons l’attention des praticiens sur la gravité potentielle de la varicelle de l’adulte et surtout sur la contre-indication formelle des stéroïdes et des AINS.

L’effet associatif entre les constituants d’une ration peut induire un effet positif ou negative sur les performances de production des ruminants,en function de la nature des constituants de la ration. De plus, La prediction de la valeur alimentaire de la ration sur la base de la somme des valeurs des constituants comporte beaucoup de limites. Deux essais ont été conduits pour évaluer l’effet associatif entre du tourteau de graine de coton non décortiquée (TBM) et les gousses de Piliostigma reticulatum (GP) sur l’ingestion volontaire (essai 1) et la fermentation in vitro à l’aide de la technique du gaz test (essai 2) de la paille de riz seule (PS) ou avec la mélasse et l’urée (PMU). Le TBM a été ajouté à PS ou à PMU dans la proportion: 70 / 30 (PS/TBM ou PMU / TBM). Les GP ont été ensuite substituées au TBM dans la proportion de 15%. Quatre rations ont été formulées pour l’essai 1: R1 (70% PS + 30% TBM), R2 (70% PMU + 30% TBM), R3 (70% PMU + 15% TBM + 15% GP) et R4 = R3 mais TBM et GP ont été distribués de façon séquentielle. Deux autres rations: 100% PS et 100% PMU en plus des rations précédentes, ont servi de substrats pour le gaz test. La ration R2 comparée à R1 a significativement (p < 0.05) amélioré les performances de croissance des taurillons. Par contre, l’apport de GP n’a pas eu d’effet car les GP n’ont pas été consommées tout au long de l’essai. Contrairement aux traitements PS et TBM (essai 2), les traitements PMU et TBM ont engendré une augmentation significative (p < 0.05) du taux horaire (c) de fermentation de la fraction insoluble (b), la concentration des acides gras volatiles (AGV) et la production de gaz à 12, 24, 36 et 48 h. L’interaction entre PMU, TBM et GP a été positive et significative. L’apport de la mélasse-urée en plus du tourteau et les gousses de Piliostigma a permis d’améliorer la valeur nutritive de la paille de riz. The associative effect between the constituents of a ration can positively or negatively affect ruminant animals ‘performances, depending on the nature of the constituents of the ration. Moreover, predicting the feeding value of the ration by simply adding the individual feed value of the constituents has some limitations. Two trials were conducted to assess the associative effect between unhulled cottonseed meal (TBM) and Piliostigma reticulatum pods (GP) on voluntary intake (trial 1) and in vitro fermentation using the gas production technique (trial 2) of rice straw alone (PS) or PS with molasses and urea (PMU). TBM was added to PS or PMU in the proportion: 70/30 (PS/TBM or PMU/TBM). The GPs were then substituted for the TBM in the proportion of 15%. Four rations were formulated for trial 1: R1 (70% PS + 30% TBM), R2 (70% PMU + 30% TBM), R3 (70% PMU + 15% TBM + 15% GP) and R4 = R3 but TBM and GP distributed sequentially. Two other rations: 100% PS and 100% PMU in addition to the previous rations, served as substrates for the gas test. The R2 ration compared to R1 significantly (p < 0.05) improved the growth performance of the young bulls. On the other hand, the supply of GP had no effect because the GP were not consumed throughout the trial. Unlike the PS and TBM treatments (trial 2), the PMU and TBM treatments generated a significant increase (p < 0.05) in the hourly rate (c) of fermentation of the insoluble fraction (b), the concentration of volatile fatty acids (VFAs) and gas production at 12, 24, 36 and 48 h. The interaction between PMU, TBM and GP was positive and significant. The supply of molasses and urea in addition to cottonseed cake and Piliostigma pods improved the nutritional value of rice straw.

Summary: Introduction: Knowledge of the birth cycle is important in the organization of reproductive health services in a facility. The main objective was to study the determinants of the birth cycle at the Kalaban-Coro health center. However, it seems that there are other determinants of the birth cycle, hence the relevance of this study. Material and methods: This was a cross-sectional analytical study from October 1 to December 31, 2020. Results: The study included 977 parturients who gave birth in the department. It recorded more night deliveries (59.1%) than day deliveries (40.9%). The average age of the women was 25 years. Non-educated births were the most represented with 39% of cases. Nocturnal admissions were predominant (58.8%); 59% of parturients had a history of nocturnal delivery and 40% preferred to give birth at night, while 30% had no preference. At admission, 57.91% of parturients were in the active phase during the night, compared to 42.59% during the day; 52.6% of parturients had a nocturnal onset of labor, compared to 47.4% during the day. Conclusion: The study showed that childbirth is more frequent at night than during the day. It highlighted the admission nycthemer, the previous nycthemer of deliveries and the preference of the parturient as other determinants of the nycthemer of the delivery.

Ectopic pregnancy is the leading cause of maternal morbidity and mortality during the first trimester of pregnancy. There has been a dramatic increase in its incidence since the advent of IVF followed by in vitro Embryo Transfer (IVF-ET). Many risk factors related to IVF techniques and the cause of infertility have been documented. The combination of Endo Vaginal Ultrasonography and Human B Chorionic Gonadotropin (HCG) assays is the most reliable diagnostic tool, sometimes allowing the trunk to be preserved.

RESUMELes mutilations genitales feminines sont des pratiques traditionnelles qui causent de nombreuses complications desastreuses, aussi bien precoces que tardives. La mutilation sexuelle feminine la plus frequemment pratiquee est l’excision, c’est-a-dire l’ablation totale ou partielle du clitoris, parfois accompagnee de la mutilation des petites levres. Certaines populations pratiquent l’infibulation : en sus de l’intervention precedente, les grandes levres sont mutilees, puis rapprochees et cousues. Les auteurs rapportent le cas d’un kyste geant vulvaire post-mutilation genitale survenu chez une jeune femme plusieurs annees apres avoir subi une excision. La localisation vulvaire de cette grosse masse a ete a la base d’un inconfort et d’un gene esthetique. L’exerese chirurgicale realisee a donne des resultats esthetiques et fonctionnels satisfaisants chez la patiente.ABSTRACTFemale genital mutilation is a traditional practice that causes many disastrous complications, both early and late. The most frequently performed female genital mutilation is excision, that is, the total or partial removal of the clitoris, sometimes accompanied by mutilation of the labia minora. Some populations practice infibulation: in addition to the previous procedure, the labia majora are mutilated, then brought together and sewn. The authors report a case of a post-genital mutilation giant vulvar cyst that occurred in a young woman several years after undergoing excision. The location of this large mass in the vulva was the source of discomfort and an aesthetic gene. The surgical excision performed gave satisfactory aesthetic and functional results in the patient.

RESUME But. Faire le bilan de notre activite d’adenomectomie prostatique transvesicale. Patients et methodes. Il s’agit d’une etude transversale avec collecte prospective des donnees, allant de Fevrier 2007 a Decembre 2012. Les dossiers de tous les patients operes pour adenome de la prostate par la voie transvesicale dans l’unite de chirurgie generale du Centre de Sante de Reference de la Commune VI (CS Ref CVI) du district de Bamako, ont ete inclus dans cette etude. Resultats. Nous avons collige en 5 ans 133 dossiers soit 51,35% des pathologies urologiques et 14,3% de l’activite chirurgicale. L’âge moyen etait de 68 ans. Les patients venus spontanement representaient 97 cas (72,9%). Les pathologies associees etaient la hernie inguinale et la lithiase vesicale 3 cas (2,25%) chacune. Les circonstances de decouverte etaient la retention aigue d’urine 54 cas (40,6%) et la dysurie 41 cas (30,8%). Le globe vesical etait trouve dans 97 cas (72,9%). Le toucher rectal a trouve une augmentation de volume de la prostate ferme et reguliere dans 132 cas (99,24%). Le PSA etait eleve dans 7 cas (5,3%). L’adenomectomie etait effectuee dans 129 cas (96,99%). L’anatomie pathologie revelait 3 cas (2,3%) d’adenocarcinome. Les suites immediates ont ete simples dans 131 cas (98,5%). La duree d’hospitalisation moyenne a ete de 6 jours. La mortalite a ete de 1,5% (2 cas). Conclusion. Les adenomectomies prostatiques transvesicales realisees dans un hopital de seconde categorie par des chirurgiens generalistes ont eu des suites simples. Toutefois, cette technique pourrait etre reservee aux structures peripheriques et les techniques plus modernes aux centres hospitalo-universitaires. ABSTRACT Objective. To report our activity of transvesical prostate adenomectomy. Patients and methods. This was a cross sectional prospective study, covering the period from February 2007 to December 2012 (5 years). All patients operated on prostatic adenoma within the general surgical unit at commune VI’s referral health center were included. Results. We studied 133 cases of prostatic adenoma. The average age of patients was 68 years. Prostatic adenoma (133 cases; 51.35%) was the most common uropathy. Inguinal hernia (6 cases; 4.5%) and vesical lithiasis (6 cases; 4.5%) were the most common pathologies associated with adenoma. Urine retention (54 cases; 40.6%) and dysuria (41 cases; 30.8%) were the most common reasons of consultation.  On palpation, 97 patients (72.9%) have presented urinary bladder retention. Moreover, 132 patients (99.24%) had the prostatic hypertrophic on digital exam. Only 3 patients (2.3%) had associated adenocarcinoma. PSA level was abnormal in 7 cases (5.3%). Adenomectomy was done for 129 patients (96.99%). The histological analysis found 7 associated adenocarcinomas (5.26%). 131 patients (98.5% had no immediate complication. The average duration of hospitalization was 6 days. The mortality rate was 1.5% (2 patients). Conclusion. Prostatic adenomas may be operated in a secondary category hospital by general surgeons, with few complications. This technique should be limited to peripheral sanitary structures. The modern techniques will be performed by urologist in first category hospitals.

RESUMEObjectifs. Preciser le profil socio-epidemiologique des patientes referees dans une formation de sanitaire de deuxieme reference du district de sante de Bamako, et determiner le pronostic maternel et perinatal. Materiels et methodes. Nous avons realise une etude retrospective a viser descriptive sur une periode de deux ans, du 1er janvier 2017 au 31 decembre 2018 portant sur toutes les evacuations sanitaires obstetricales recues au centre de sante de reference de la commune V du district de Bamako. Resultats. Nous avons enregistre 15 755 accouchements dont 3 876 cas d’evacuation soit une frequence de 24,60%. L’âge moyen des patientes etait de 26 ans ±5,16 ans, moins d’une patiente sur cinq avait utilise l’ambulance comme moyen de transport (24 ,06%), et n’avait fait aucun suivi prenatal (21,94%).Les motifs d’evacuation etaient domines par les dystocies (52,84%), suivie de l’hemorragie (13,13%). La cesarienne a ete realisee chez 2 489 patientes (64,22%) ; la laparotomie pour rupture uterine chez 52 patientes (1,34%).Nous avons enregistre 31 deces maternels (soit 850 pour 100 000 naissances vivantes). Les principales causes obstetricales directes des deces maternels ont ete l’hemorragie avec 16 cas (51,25%), l’infection avec 10 cas (32,25%). Nous avons enregistre 985 deces perinatals soit 254 pour 1000. Conclusion. Le pronostic obstetrical chez les evacuees reste encore mauvais en Commune V du District de Bamako.ABSTRACTObjectives: To specify the socio-epidemiologic profile of the patients referred to a second level reference hospital of Bamako and to determine the maternal outcome. Material and methods. We made a retrospective study to sign descriptive over one two years period, of bearing January 1, 2017 to December 31, 2018 on all the obstetrical evacuations received at the health centre of reference of Council V of the district of Bamako. The variables of interest were as follows: maternal age, parity, number of antenatal visits, source, reason for evacuation, and diagnosis of entry, maternal and newborn outcome. Results. We recorded 15.755 childbirth, among whom 3.876 case of evacuations (24.60%). The mean age of the women was 26 years ±5.16 with (range: 15 -44 years). There were 50.43% of primiparous. 83.51% of patients came from the medical district of Council V. The percentage of women who had used the ambulance as means of transport was 24.06%. 850 women (21.94%) and had no history of antenatal visit. The main reasons for evacuation were: dystocies (52.84%) and hemorrhage (13.13%). Caesarean section was done in 2.489 patients (64.22%); laparotomy for uterine rupture in 52 patients (1.34%), vaginal maneuvers in 97 cases (2.5%) and simple vaginal childbirth in 1.238 patients (31.94%). We recorded 31 maternal deaths (850 for 100 000 deliveries). The direct causes of maternal deaths were: hemorrhage (16 cases – 51.25%), infection (10 cases - 32.25%), dystocia (4 cases – 12.9%) and eclampsia (1 case - 3.22%). We recorded 985 deaths perinatal deaths (254/1000). Conclusion. Maternal and perinatal are still high death in Council V of Bamako. Obstetrical care must be improved.

RESUME L’hydrocele de l’adulte est definie comme une collection anormale de fluide sereux dans l’espace entre les feuillets parietal et visceral de la tunique vaginale. Elle peut etre de grande abondance. Elle demeure une pathologie frequemment retrouvee en region tropicale. Nous rapportons un cas d’hydrocele de grande abondance avec epaississement de la vaginale et destruction du testicule. Il s’agit d’un patient âge de 75 ans adresse par le service de diabetologie pour hypertrophie de la prostate chez qui notre examen a trouve une grosse bourse evoluant depuis plus de 20 ans malgre le traitement traditionnel. L’inspection a montre une volumineuse bourse droite sans lesion cutanee. Nous avons evoque une hydrocele volumineuse droite. L’echographie scrotale a montre un epanchement de grande abondance d’aspect trouble (2000 ml), un epaississement de la tunique vaginale dont le diametre (8 mm) et une absence de structure testiculaire. Le diagnostic d’hydrocele unilaterale droite de grande abondance a ete retenu avec pachy-vaginalite. L’intervention chirurgicale a confirme l’absence de structure testiculaire. Elle a consiste en aspiration de 1,5 litre de liquide fortement teinte et ablation totale de la vaginale restante. Les suites operatoires ont ete simples et le patient est sorti a J2. ABSTRACT Adult hydrocele is defined as an abnormal collection of serous fluid in the space between the parietal and visceral layers of the vaginal tunica. It may be very abundant. It commonly affects people who live in tropical regions. We report the case of a 75 year old patient, living in sahelian zone with an abundant hydrocele and thickening of vaginal coat associated with a testicular destruction. The patient was referred by the diabetology unit for prostate hypertrophic but the patient also complained of a huge scrotum evolving for more than 20 years with progressive increase in volume. Clinical examination showed voluminous left scrotum without skin lesion. Our suspected diagnosis was the voluminous hydrocele. Ultrasound of the bag showed very abundant effusion in the vaginal space (2000 ml) with thickening of tunica vaginalis (8 mm) and no testicular structure. The diagnosis of the abundant unilateral hydrocele associated with pachyvaginalitis and a testicular destruction was retained. The extraction of 1500 ml of strained fluid, and resection of the vaginal tunica was performed during surgery. No test was found. Postoperative course was favorable. The patient went home on day 2.

RESUMEIntroduction. La presente etude s’inscrit pleinement dans les orientations internationales et nationales qui appellent au renforcement de la surveillance des deces maternels. C’est une forme de surveillance continue qui etablit une passerelle entre le systeme d’information sanitaire et les processus d’amelioration de la qualite des soins du niveau local au niveau national. Objectif. L’objectif de cette etude etait de decrire l’implantation du systeme de surveillance des deces maternels et Riposte (SDMR) en Commune V de Bamako. Methode. L’implantation de la surveillance des deces maternels et Riposte a fait suite au Projet essai Quarite et du Programme GESTA International de 2007a 2011. Resultats. Pour l’implantation de la SDMR, il a fallu la formation des leaders d’opinion locaux au nombre de trois (3) par des Experts venus du Canada, la France, le Senegal, et le Mali. Le processus d’implantation des revues a comporte quatre (4) etapes : la formation des formateurs ou des leaders d’opinion locaux, la constitution du comite d’audits, la mise en œuvre des audits, la formation continue du personnel soignant. Cet ensemble etait encadre par des visites des superviseurs. la riposte etait immediate et avait pour objet d’apporter des solutions aux differents dysfonctionnements ayant conduit aux deces maternels. Conclusion. L’implantation de la surveillance des deces maternels et Riposte necessite la formation des leaders d’opinion locaux indispensable a la reussite de l’activite.ABSTRACTIntroduction. The present study is fully in line with international and national guidelines which call for the strengthening of surveillance of maternal deaths. It is a form of continuous surveillance that bridges the health information system with processes for improving the quality of care from the local to the national level. Objective. The objective of this study was to describe the implementation of the Maternal Death and Riposte System (MRSA) in Commune V of Bamako. Method. The implementation of maternal death surveillance and Response has followed the Test Quarite project and the GESTA International Program from 2007 to 2011. Results. For the implementation of the MRSA, it was necessary to train three (3) local opinion leaders by experts from Canada, France, Senegal, and Mali. The process of implementing the journals consisted of four (4) stages: training trainers or local opinion leaders, the constitution of the audit committee, the implementation of audits, the continuous training of the nursing staff. This set was supervised by visits from the supervisors. The Riposte was immediate and was intended to provide solutions to the various dysfunctions that led to maternal deaths. Conclusion. The implementation of maternal deaths surveillance and Riposte requires the training of local opinion leaders essential to the success of the activity.

ABSTRACT The spigelian hernia ou ventral lateral hernia is an unusual dehiscence appearing on the line or spigelian semi-lunar fascia. It is a rare clinical entity and represents 0,1% at 1% of hernia. We report the observation of a patient aged 65 who presented a voluminous para umbilical tumefaction right partially reductible. Spigelian hernia was suspected on clinical examination. A ultrasound has suspected spigelian hernia with the small intestin mobile. A simple suture was performed after reintegration of the bag containig the small intestin. The suite postoperative were simple 2 year after. RESUME La hernie de Spiegel ou hernie ventrale laterale est une dehiscence inhabituelle apparaissant sur la ligne ou fascia semi-lunaire de Spiegel. C’est une entite clinique rare, represente 0,1 a 1% des hernies. Nous rapportons l’observation d’une patiente âgee de 65ans qui consulte pour tumefaction para ombilicale droite reductible partiellement. Une hernie de Spiegel etait suspectee a l’examen clinique. Une echographie suspectait une hernie de Spiegel. Une simple raphie etait realisee apres reintegration du sac contenant des anses adherees. Les suites operatoires etaient simples avec un recul de 2 ans.

RESUME Introduction. L'une des cibles de l'Objectif de Developpement Durable 3 est de faire passer le taux mondial de mortalite maternelle au-dessous de 70 pour 100 000 naissances vivantes et celui de la mortalite neonatale a 12 pour 1 000 naissances vivantes au plus. L’atteinte de cet objectif dependra en partie d’une bonne couverture en soins pre-nataux. Nous nous proposons ainsi d’evaluer les risques lies aux grossesses non suivies dans le district sanitaire de la commune V de Bamako. Materiels et methodes. Il s’agissait d’une etude cas/temoin qui s’est deroulee dans le district sanitaire de la commune V de Bamako sur une periode de trois mois, allant du 1er Janvier au 31 Mars 2017. Nous avons inclus toutes les femmes non suivies en prenatal et ayant accouche dans une des structures du district. Nous avons apparie l’âge et la parite. Le domaine d’interet etait l’issue obstetricale. Resultats. Nous avons trouve 709 grossesses ( 13,8%) non suivies en consultation prenatale. L’âge moyen des femmes etait e 23,45 ± 9,56 ans avec des extremes de 13 et 42 ans. Le profil des femmes sans suivi prenatal etait celui d’aides menageres (OR=2,5 [2,0-3,4]), de celibataires (OR=2,3 [1,8-2,8]), de non instruites (OR=1,1 [0,9-1,3]). Comparees a celles qui avaient effectue une consultation prenatale, les patientes non suivies avaient un risque plus eleve de complications obstetricales et la difference etait statistiquement significative (OR>1). Il s’agissait de risque eleve d’evacuations obstetricales, de rupture prematuree des membranes, de post maturite, petits ou faible poids de naissance, de troubles hypertensifs, de rupture uterine, d’arret de l’evolution de la grossesse (mort fœtale), d’anemie, de malpositions fœtales, de cesarienne, d’hemorragie du post partum immediat, d’infection puerperale et de deces maternel. Ces femmes avaient aussi un risque plus eleve de deces neonatal precoce, de depression chez le nouveau-ne (score d’Apgar 1). Those obstetric complications were: premature rupture of the membranes, post-maturity, low or low birth weight, hypertensive disorders, uterine rupture, termination of the course of pregnancy (fetal death), anemia, fetal malpositions, cesarean section, hemorrhage immediate postpartum (HPPI), puerperal infection and maternal death. These women also had a higher risk of early neonatal death, low Apgar score (<8) of neonates and transfer to neonatology. Conclusion. In our setting, pregnancies without evidence of antenatal consultation have a statistically significant higher risk of maternal and perinatal mortality.

The aim of this work was to compare the prognosis of induced pregnancies and spontaneous pregnancies received in the service.PATIENTS AND METHODS:We performed a retrospective study of Ca / Witnesses (1 case for 2 controls) with age and parity matching. This study was conducted at the maternity ward of the Reference Health Center of Commune V District Bamako (CSREF CV) over a period of 10 years from January 1, 2007 to December 31, 2016 for all patients meeting our criteria of 'inclusion. We called cases, induced pregnancies, and witnessed spontaneous pregnancies. The data was entered and analyzed on the Epi-Info software version 6.04 according to the formula applicable to the Case / Witness study.RESULTS:We included in this study, (due to a case for two controls), 1611 induced pregnancies (cases), and 3222 spontaneous pregnancies (controls). The average age was 35.4 years (25 years-43 years) with an average parity of 2.7 (1-5). Hypertensive disorders, preterm birth, intrauterine growth retardation (IUGR), caesarean section, poor perinatal prognosis were found with a statistically significant difference (OR> 1) in patients with induced pregnancies.CONCLUSION:Induced singleton pregnancy is a high-risk pregnancy.