Traumatic injuries of the upper limb quite frequently cause acromioclavicular lesions including acromioclavicular disjunction (ACD). In our context, its management is problematic regarding the indications of surgical treatment on one hand and the choice of the surgical technique on the other hand. Among the many techniques available, that of Weaver-Dunn is one of the most popular for its simplicity of realization and its efficiency. In this respect it seems the most appropriate because of the socio-economic conditions of the population because it does not require a double intervention in this case the removal of osteosynthesis equipment. In this series, we report 3 cases of at least stage 3 DACs, all treated with this technique with good functional results.

Pregnancy, which is responsible for the decline in immunity, and the immediate postpartum period can lead to reactivation or worsening of tuberculosis. We report a case of a patient who consulted for neurological disorders in the context of a deterioration in general condition. The CT scan revealed a brainstem lesion which was successfully treated like a tuberculosis. However, reactivation has been observed in the postpartum period of a pregnancy contracted during anti-tuberculosis treatment. Further clinical improvement has been achieved with anti-tuberculosis treatment. Pregnancy and the immediate postpartum had led to a transient decline in immunity in part by decreasing in the inflammatory activity of type 1 helper T cells so that the fetus, which is a foreign body, was accepted by the maternal body. This decline in immunity during pregnancy and the immediate postpartum period due to immune reconstitution had been responsible for a high degree of vulnerability, usually characterized by a significant exacerbation of tuberculosis symptoms and an unfavorable course of disease.

AIMS:Cerebral hydatic cysts are common in North African and pastoral countries but still underdiagnosed in sub-saharian ones.We report the first two casesoperated in Mali andhistologically proven of cerebral hydatic cysts.PATIENTS AND METHOD:Our study was aboutabout a 46 years old patient, admitted for Bravais-Jacksonian crisis, dysarthry and right hemiparesy, and another 38 years old male one, with a intracranial hypertension syndrome associated with cranial fistulized cerebral hydatic cyst.The CT scan has shown a cerebral cyst in the first case and multi-locular cysts in the second. The patients underwent surgery, with complete removal in one case and a rupture in the second case, but with a good outcome. Anatomo-pathological analysis concluded to hydatic cerebral cysts in both cases.CONCLUSION:With these first cases, the diagnosis of cerebral hydatic cyst must be evoked more frequently in our countries, because of the evolution of radiological diagnosis and surgical abilities.

INTRODUCTION:The appearance of spontaneous subdural hematoma (SSDH) is a rare phenomenon in chronic hemodialysis and is burdened with significant morbidity and mortality. It's prevalence remains low in Sub-Saharan Africa, is 0.43%. We report a case of SSDH in a young hemodialysis patient with favorable outcome after medico-surgical management.CLINICAL OBSERVATION:This is a 35-year-old patient who has been hemodialysed since June 2016 for chronic renal insufficiency of hypertensive origin. He was admitted on 18 July 2018 in the nephrology department of CHU Point G for intense headaches in a context of dysarthria. They associate themselves with speech disorders, photo-phonophobia, uncontrollable nausea and vomiting. It does not report any notion of head trauma. The physical examination noted dysarthria, a right pyramidal syndrome made of right Babinsky sign, right arm deficit at 4/5, and right hemicorporeal hyperkinesia. He weighed 62 kg for 165 cm, the blood pressure was 187 / 110 mmHg. The patient had clinical signs of extracellular dehydration. Non-injected cerebral CT showed an acute left sub-dural hematoma with peri-lesional cerebral hypodensity. Surgical evacuation of the hematoma through a trephine hole is performed under local anesthesia. The postoperative course was simple. His hemodialysis sessions were done without heparin from diagnosis until 23 days post operatively.CONCLUSION:Spontaneous subdural hematoma is multifactorial and rare in the dialysis patient. Despite high morbidity and mortality, hemodialysis should not refute surgical management of subdural hematoma.

Le tuberculome est l'une des rares causes infectieuses de compression médullaire. Il est responsable de troubles neurologiques importants avec des séquelles considérables. L'objectif était de discuter des aspects physiopathologiques et la conduite thérapeutique du tuberculome intramédullaire. Patient et méthode : Le patient de 32 ans sans antécédents particuliers a présenté un syndrome de compression médullaire lente. La chirurgie associée à l'examen anatomopathologique ont permis de poser le diagnostic. Une antibiothérapie antituberculeuse a été instaurée en traitement de fond. Après 15 mois, l'évolution était marquée par la persistance des troubles neurologiques. Conclusion : La prise en charge précoce et adéquate du tuberculome intramédullaire limite le risque de complication mais ne garantis pas une évolution sans séquelles

INTRODUCTION:Healthcare-associated infections or nosocomial infections are a public health problem due to their frequency, severity and economic impact. They cause an increase of the morbidity, the mortality, the hospital stay and the expenses of taking care of the patients. According to the WHO, 7.1 million people are affected each year, of which about 100,000 die.AIM OF STUDY:The aim of this study was to determine the frequency of healthcare-associated infections in the Neurosurgery Department of Gabriel Touré University teaching Hospital and to identify the risk factors associated with these infections.MATERIAL AND METHODS:This was an epidemiological, descriptive, analytic, cross-sectional and prospective study lasting 6 months from May 29 to November 30, 2016. The study focused on patients who stayed more than 48 hours in the Neurosurgical department Gabriel Touré teaching hospital. The collected data focused on the clinical and biological characteristics of the patients during their hospitalization. The maximum size of the sample was 200 patients. A sample was taken for each type of infection. The criteria used for the diagnosis of Healthcare-associated infections were those of the CDC (Center for Disease Control) and the realization of a thick drop in our context. The chi-square test was used for the comparison of qualitative variables and Kruskal Wallis and Anova for quantitative variables. The materiality threshold has been set to a value of p less than 0.05.RESULTS:At the end of our study, we had 34 infected patients out of 200, a rate of 17%. The significant risk factors found in our study were: high age (p = 0.04), ASA class (p = 0.002), pre-surgical shaving (p = 0.02), long duration surgical intervention (p = 0.002) and long hospital stay (p = 0.004). The types of infections associated with the care found were: urinary in 18 (53%) cases, respiratory in 9 (26%) cases, operative site in 6 (18%) cases and 1 (3%) cases of bacteremia. The bacterial spectrum of these infections was dominated by Negative Gram Bacilli, among which Escherichia coli in 11 (32.3%) cases. The clinical course of patients treated for these infections was marked by healing in 31 (91.2%) cases, complications in 2 (5.9%) cases, and death in 1 (2.9%) case.CONCLUSION:The prevalence of Healthcare-associated infections in our department remains high compared to that found in developed countries. This study allowed us to identify the main risk factors associated with these infections. A stricter adherence to the rules of hygiene and prevention of Healthcare-associated infections is needed to reduce this rate.

Extra Dural hematoma is a fairly common complication in traumatic cranial patients whose prognosis depends on early and appropriate management.PURPOSE:To carry out an epidemiological, clinical and therapeutic study of extradural haematomas operated in department.METHOD:A retrospective and descriptive study carried out in the neurosurgery department of the Gabriel Toure hospital spread over a period of 5 years. All records of the patients who underwent extra-dural hematoma surgery were stripped, for a total of 112. Data related to socio-professional, clinical and therapeutic characteristics were studied.RESULTS:The mean age was 24.47 years with extremes ranging from 3 to 53 years old. The ratio was 9.2 in favor of the man. Road accidents are more frequent with 66.1%. The free interval was founding 68.2%. At admission, 5.4% of patients shad a glascow scale of less than 8, anisocoriain 33.1% and contralateral motor deficit 43%. CT allowed the early diagnosis of 100% extra dural hematoma. 42.9% of patients were operated on before the first 8 hours. Mortality was 4.4%.CONCLUSION:Extra duralhematomais a neurosurgical emergency with good prognosis if management isearly and appropriate.