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The aortic aneurysm is the 13th leading cause of death in Western countries. The incidence of thoracic aortic aneurysms is estimated at 4.5 cases per 100,000. The diagnosis is often made on a chest x-ray or other imaging tests, such as an echocardiogram done for other heart diseases. Echocardiography is the first test to assess the diameter of the ascending aorta and its progression over time. Most patients are first assessed and followed up with spiral thoracic computed tomography with injection of contrast medium, supplemented by 3-dimensional reconstruction of the aneurysm in order to improve the accuracy of measurements, identification of its proximal part and distal. When dilation of the ascending aorta reaches the critical diameter of 50 mm, there is a risk of aortic dissection or rupture. Supravalvular aneurysms are treated by replacing the ectatic portion with a Dacron&#174 tube in the supracoronary position. Aortic root aneurysms, including coronary ostia, require tube replacement, reimplantation of coronary ostia, as well as surgery on the aortic valve. In this article, we report a case of aneurysm of the aortic root and the ascending aorta treated by aortic valve replacement and the ascending aorta associated with the Cabrol hemi-mustache technique and we review the literature.

Objective: In light of numerous obstetric evacuations to the Point G University Hospital and taking into account the practice of cesarean section for many years in the service, it seemed necessary to us to make our contribution to the study of cesarean section by putting emphasis on maternal and perinatal prognosis in the Obstetric Gynecology Department of the Point G university hospital. Method and materials: We conducted a retrospective cross-sectional study in the Gynecology and Obstetrics Department of the Point G University Hospital, from January 01, 2018 to December 31, 2018. The Point G University Hospital is a 3rd level center of reference in the field of obstetrics in Mali. There is no neonatal ward. The study included all women who gave birth in the gynecology and obstetrics department during the study period. All prophylactic and emergency Caesarean section records during the period in which management took place in the ward were included. The records of patients who had a prophylactic or emergency cesarean section in other health facilities and non-usable records were not included. Data were collected using a pre-established survey form. The variables analyzed were socio-epidemiological, clinical and prognostic. Data were analyzed using IBM SPSS software version 16.00. The Chi2 test and Fischer’s exact test were used to highlight risk factors. The significance level retained was p 0.05. Operational definition: Nulliparous: A woman who has never given birth; Primipara: A woman who gave birth once; Pauciparous: A woman who has a number of deliveries between two and three; Multiparous: A woman who has a delivery count of between four and six pregnancies; Large multipara: A woman who has given birth more than six times. Results: We recorded 608 deliveries by cesarean section out of a total of 1573 deliveries, i.e. a rate of 38.6%. The majority of caesarized patients were between 20 and 29 years old or 41.94%, the average age was 26 years old. Out-of-school patients were the most represented, or 44.41%. They were pauciparous in 34.4% of cases. The pregnant majority had performed at least 04 antenatal consultations, or 68.91%. In 74, 51% of the cases the patients carried a pregnancy estimated to term. Cesarean section was performed urgently in 85.36% of cases and eclampsia crisis was the most common maternal indication, or 27.97% among the 379 cases. We recorded 10 maternal deaths or 1.64%. The bleeding disorder was responsible for half of our deaths, or 50%, from retro-placental hematoma. The fetal prognosis was dominated by neonatal distress with 19.08% of cases. We recorded 101 cases of stillbirths, or 16.61%, and 23 cases of early neonatal death, or 3.78%. Our study found a statistically significant relationship between the type of cesarean section and neonatal death with Fisher’s exact test = 27.772, P 0.0001.

Through its impact on morbidity and mortality and the cost of medical care, Venous Thromboembolism (VTE) has a significant influence on the quality of care in a surgical environment. The objectives were to determine the risk of postoperative venous thromboembolism and to assess its prophylactic management in the general surgery department of Gabriel Toure University Hospital. This was a prospective observational study from May 01, 2018 to December 31, 2018. It included all patients of 18 years old and over, operated in regulated surgery, under general anesthesia in the department. For all of these patients, Caprini score was used to assess the risk of VTE. The ninth American College of Chest Physicians’ Consensus was used as guidelines to assess Thromboprophylaxis practices in the ward. The Caprini score was evaluated in 80 patients for 8 months. The average age was 50.2 years. The sex ratio was 0.48. The risk level of VTE was low in three patients (3.8%), moderate in 13 patients (16.3%), high in 34 patients (42.5%) and highest in 30 patients (37.5%). The main risk factors found were major surgery (87.5%), age > 40 years (72.5%), cancer (33.8%), bed rest (31.2%), obesity (27.5%) and minor surgery (12.5%). Early mobilization was performed in all patients. Pharmacologic prophylaxis was required in 80% of our patients but only 38.8% had received low molecular weight heparin. VTE complicated 5 procedures, including 3 cases of deep vein thrombosis of the limbs and 2 cases of pulmonary embolism who died. Venous thromboembolism is serious and common in surgical settings. Its prevention remains insufficient in our context.

Introduction: Cardiac myxomas represent the most frequent forms of primary tumors of the heart. The most frequent location is the interatrial septum. We report the clinical case of a myxoma of the left atrium and discuss its epidemiological and therapeutic aspects through a review of the literature. Observation: This was a 41-year-old female patient who presented with sudden rotational dizziness associated with vomiting. MRI revealed multiple punctiform bilateral supra and subtentorial strokes of different ages, recent and semi-recent, suggesting an embologenic etiology. Transesophageal echocardiography found a large pedunculated, homogeneous, avascular tumor hanging from the interatrial septum. The patient is operated on urgently under cardiopulmonary bypass for resection of a large tumor located in the left atrium. The pathological examination concluded with the diagnosis of myxoma of the left atrium. The postoperative follow-up was straightforward and the patient was discharged from the hospital via home hospitalization. Conclusion: The diagnosis of cardiac myxomas is suspected in the presence of symptoms associated with echocardiographic images of intracardiac masses and confirmed by histological study. Embolic accidents are one of the formidable complications of myxomas. Surgical management is urgent, especially in the presence of predictive morphological features of embolism on echocardiography.

Tuberculosis is a public health problem in Mali. Pulmonary localization is the most frequent and extra-pulmonary involvement, in particular serous, is possible. In this study, we analyze our results of surgical pericardial drainage in tuberculous pericarditis. Methodology: We carried out a retrospective study at the CHU Point G over a period of five years from January 2012 to December 2017. The histological examination carried out on all the surgical specimens made it possible to retain the diagnosis of tuberculous pericarditis. Results: We identified and operated on 49 cases of tuberculous pericarditis, i.e. 70% of the pericardial drainage performed during the same period. The average age was 31.5 years (28 men and 21 women). The most common clinical signs were dyspnea (61.2%), chest pain (26.6%) and fever (12.2%). Pericardial drainage with pericardial biopsy was performed by xiphoid route in all of our patients. The mortality and morbidity rates were 4.1% and 8.2%, respectively. Conclusion: Pericardial tuberculosis attacks are frequent in Mali. The etiological diagnosis is based on the histology of the pericardial biopsy which can only be obtained surgically.

Small bowel obstruction (SBO) is defined as a complete and persistent cessation of the transit of materials and gases. It occurs in a segment of the digestive tract located between the pylorus and the colorectal junction. We report an observational study which aims to describe the epidemiological, clinical and therapeutic aspects of small bowel obstruction. This study was carried out in the General Surgery Department of Hopital Somine DOLO de Mopti from October 1, 2016 to October 1, 2018. A total of 114 patients were recorded for whom the diagnosis was related to an occlusion. The median age was 37 years with extremes ranging from 6 months to 90 years. Male sex was predominant with a sex-ratio of 1.8. The frequency of small bowel occlusions over all occlusions was 74.03%. The most encountered clinical signs were as followed: abdominal pain (100%), vomiting (88.6%), cessation of materials and gas (79.9%) and meteorism (62.3%). All patients underwent medical imaging, the most common of which was an abdomen without preparation X-ray (AWP). On the etiological level, the main causes found postoperatively were: flanges and adhesion (55.2%), strangulated hernias (28.0%), acute intussusception (6.1%), small bowel volvulus (3.5%) and small bowel tumor (1.6%). Releasing the bridles was the most common surgery process (28.0%). The morbidity of the immediate follow-up was (13.1%) and the mortality was (7.0%). This high mortality is due to ignorance of the signs of seriousness and the socio-cultural barrier (decision of the patriarch to agree to a surgical intervention), the late use of hospital facility and the limited financial capability of the patients.

Introduction: Endoscopic internal urethrotomy (EIU) is a technique that consists of an incision of the stenosed urethra under visual control. Its indication is widespread since the first description in 1971 by Sachse. The objective was to analyze the results of EIU in the treatment of urethral stenosis (US) at the Andro-Urology Department of the UHC of Conakry. Methodology: It is a prospective descriptive study, lasting 18 months (January 2016-30 June 2017). It involved 102 patients. The variables were: age, etiology of US, type of catheter, duration of catheter wear and recurrences. After a 12-month follow-up, our results were considered good in the absence of recurrences. Results: The average age was 54.25 years with the extremes comprising between 16 and 96 years. The main reasons for medical checkup were chronic urine retention at 58.82%. Etiology infection was the most frequent with a ratio of 81.37%, while Escherichia coli was found at 51.29%. US was bulbar (71.57%), unique (67.64%) and less than 1 cm (60.78%). Surgical complication occurred with 9 patients (8.82%) with urethrorrhagia and the external genital organs infiltration in 4 cases. Results were good for 77 patients (75.49%). Stenosis post infection, long and multiple stenoses, urethral catheterization with latex catheter and urethral catheterization of more than 4 days were strongly associated with the recurrence occurrence. Conclusion: The EIU is a minimally invasive surgical technique that offers good results.

Aim: To perform a vector 3D reconstruction of the neck skeleton from the anatomical sections of the “Korean Visible Human” for educational purposes. Material and Methods: The anatomical subject was a 33-year-old Korean male who died of leukemia. It measured 164 cm and weighed 55 kgs. The anatomical cuts were made in 2010 after an MRI and a CT scan. A special saw (cryomacrotome) made it possible to make cuts on the frozen body of 0.2 mm thick or 5960 slices. Sections numbered 1500 to 2000 (500 neck sections) were used for this study. Manual contouring segmentation of each anatomical element of the anterior neck area was done using Winsurf software version 3.5 on a PC. Results: Our vector 3D neck model includes the following: cervical vertebrae, hyoid bone, sternum manubrium and clavicles. This vector model has been integrated into the virtual dissection table Diva3d, a new educational tool used by universities and medical schools to learn anatomy. This model was also put online on the Sketchfab website and printed in 3D using an ENDER 3 printer. Conclusion: This original work is a remarkable educational tool for the study of the skeleton of the neck and can also serve as a 3D atlas for simulation purposes for training therapeutic gestures.

Objective: To describe the screening for uterine cancer by visual methods. Method: We conducted a prospective and descriptive study over a period of 12 months from January to December 2020. Direct observation of providers and interview of patients were performed for data collection. Results: Out of 3400 patients, 1024 were enrolled for the study, or 30.11%. The average age of the patients was 41 years with the extremes of 17 to 87 years. Women aged 40 to 45 were the most represented with 58.78%, (n = 602). Housewives 85.83% (n = 879), they had a primary education level in 71.09% of cases (n = 728), the vast majority were married 92.28% (n = 945). Multiparous represented 58.78% (n = 602) of the sample, nulliparous 18.26% (n = 187), women living in rural areas 30.17% (n = 309), in urban areas 69.82% (n = 715). The test was positive in 43 patients (4.19%) but squamocylindrical junction was not visible in 17% of cases. The preparation of acetic acid and lugol: good preparation in 100% of cases; the conditions of use are not respected in 27% for acetic acid and 38% for lugol. Conclusion: Routine screening for cervical cancer (SCC) by visual methods is essential to decrease the incidence of invasive cervical cancer.

Background:The objective of this work was to evaluate the first results of the radio ablation of the great saphenous vein in the processing of chronic venous insufficiency. Method: This is a monocentric retrospective study of radio ablation of the great saphenous vein using VNUS Closure® FAST for superficial venous insufficiency of the great saphenous vein, between January 2012 and December 2014. Results: 42 patients (57 limbs) were operated on with this technology. There were 33 women and 9 men (mean age: 46.5 years). Thirty-nine patients (92. 8%) were symptomatic. Thirty-two patients (76.1%) were classified CEAP 2. The average diameter of the saphenous vein was 8.5 ± 1.5 mm. Three patients (7.1%) had a percutaneous approach. A perfect occlusion of the saphenous vein was observed in all patients. No incident or undesirable event was observed during the procedure. One case of delayed deep-vein thrombosis was observed. At one month of follow-up, six patients (14.2%) had induration opposite to the occluded vein. Forty-three percent of the patients stated they were very satisfied with the procedure. Conclusion: The effectiveness, security and simplicity of the closure method are real. More studies are necessary to assess the long-term results of this procedure.

This study on Menstrual Hygiene Management (MHM) was carried out in two secondary schools in the Bamako district, “Chaine Grise” and “Cheick Modibo Diarra” located respectively on the right bank and the left bank depending on the geographic position of the Niger river. This work took place over a period of 6 months from January 2019 to June 2019. The objective of this study was to study menstrual hygiene management in school setting for girls aged 16 to 18 in two secondary schools in Bamako. It was a transversal and qualitative description. The study population consists of girls aged 16 to 18 years enrolled in one of the selected secondary schools. At the end of this study, we arrived at the following results: *50% of the girls in our study have poor knowledge about menstruation; *10% of girls miss school at least one day a month during menstruation; *90% of girls use hygienic cotton to absorb menstrual blood; *90% of the sources of supply for hygienic products are mothers. The unsanitary conditions of the toilets, lack of light and the non-separation of the toilets according to gender guidelines were found in 99% of the cases: *99% of girls say that the poor state of health infrastructures was one of the causes of genital infections linked to poor management of menstrual hygiene; *lack of water in the toilets (99%). Through these results, we conclude that, in our context, menstruation remains a taboo and shameful subject for girls. In addition, some of their menstrual hygiene practices are a real danger to their health.

We report a case of torsion of an ovarian tumor in a 68-year-old woman with no medical and surgical history. The diagnosis was made in front of an intermittently painful pelvic mass. The treatment consisted of a left annexectomy; the anatomopathological examination revealed a fibro-inflammatory and hemorrhagic cyst. Postoperative results were simple with a 12-month follow-up.

The sigmoid volvulus is an acute strangulation of the colon by the twisting of the sigmoid loop around its mesenteric axis resulting in partial or complete obstruction of the colonic lumen. It is the most common intestinal volvulus and is an absolute medical and surgical emergency. Objectives: Determine the frequency of sigmoid colon volvulus, describe clinical and para-clinical signs, describe treatment, and determine morbidity and mortality. Methodology: This was a retrospective and prospective study performed in the General Surgery Department of Sikasso. This study concerned patients admitted and operated for sigmoid volvulus from January 1, 2014 to December 31, 2017. Retrospective Phase: We have created survey cards to study the following parameters: 1) The age and the sex; 2) The clinical signs and associated defects; 3) The radiological examinations, endoscopic; 4) The established treatment whether medical, or surgical; 5) The evolution and the postoperative consequences; 6) The admission period. Prospective Phase: At the admission each patient to benefit: a complete interrogation, a complete physical examination, additional examinations including radio of the abdomen without preparation, the rate of hemoglobin and hematocrit, grouping/rhesus. Support: Our data were collected from medical records and operating records of patients in the department. Results: We collected 54 cases of sigmoid volvulus (the annual frequency was 13.5 cases for year), which accounted for 58.1% of colonic occlusions 19.6% of intestinal occlusions and 5.9% of operative operations in emergency. The average age was 47.13 with extremes of 18 and 102 years, The sex ratio is 4.40% in favor of men. Abdominal pain, vomiting, stopping of materials and gases were present in 32 (59.3%) patients. Von Wahl’s triad was present in 36 patients (66.7%), the rectal ampoule empty in 92.6%. On the X-ray of the abdomen without preparation, 70.37% of the image was recorded as a double leg. The sigmoid was necrotic in 37% of cases, and a sigmoid volvulus and necrotic hail in 7.4% of cases. We found a simple sigmoid volvulus in 61% of cases. We performed an immediate anastomosis resection in 63%, a Hartmann resection in 29.6%, an immediate anastomosis resection plus an ileostomy in 7.4%. Operative follow-up was simple in 85.2%, with a morbidity of 11.1%, and a mortality of 14.8%. Conclusion: Sigmoid volvulus is a serious surgical emergency requiring early diagnosis and management to improve prognosis. Pre-, postoperative and postoperative resuscitation associated with immediate anastomosis resection, or resection plus Hartmann, would reduce morbidity and mortality.

Roughly quadrangular, the chiasma presents many morphological variations. The optical chiasm, odd and symmetrical structure of the optical pathways, is a required passage of the axons of neurons for the visual pathways. Any modification of its morphology evokes a pathological process, generally tumoral. The quality of MRI images rivals that of anatomical slices. So the MRI is essential for the study of the chiasma. The aim of this work was to study the morphometry of the optic chiasm in patients addressed for cerebral MRI to the imaging department of the university hospital of the POINT-G, during the period from July 29, to November 30, 2016. All patients who had a normal examination of the optic chiasma, numbering 15, were included in this study. In 86.66% of cases the chiasma had a quadrilateral form. Its average length was 8.73 mm and its average width was 13 mm. The average thickness was 4.13 mm.

Aim: To carry out a 3D vector reconstruction of the typical cervical vertebra from anatomical sections of the “Korean Visible Human” for educational purposes. Material and Methods: The anatomical subject was a 33-year-old Korean man who died of leukemia. He was 164 cm tall and weighed 55 kg. This man donated his body to science. Her body was frozen and cut into several anatomical sections after an MRI and CT scan. These anatomical sections were made using a special saw called a 0.2 mm thick cryomacrotome. Thus 8100 cuts were obtained. Only the sections numbered 940 to 1200 were used for our study. A segmentation by manual contouring of the different parts of the typical cervical vertebra was made using the software Winsurf version 3.5 on a laptop PC running Windows 7 equipped with a Ram of 8 gigas. Results: Our 3D vector model of the typical cervical vertebra is easily manipulated using the Acrobat 3DPDF interface. Each part of the vertebra accessible in a menu can be displayed, hidden or made transparent, and 3D labels are available as well as educational menus for learning anatomy. Conclusion: This original work constitutes a remarkable educational tool for the anatomical study of the typical cervical vertebra and can also be used as a 3D atlas for simulation purposes for training in therapeutic gestures.

Every woman has the right to receive satisfactory quality prenatal care in reproductive health. Giving a life while remaining alive and without sequelae must be the slogan of any gynecologist - obstetrician and midwife, as well as any health worker. It was a descriptive cross-sectional study dealing with the evaluation of the quality of prenatal consultations at the Kadiolo referral health center (or RHC). Adevis Donabedian’s model for assessing the quality of care and services served as a benchmark. According to Donabedian quality means good technical care, with good interpersonal relationships, and adequate and comfortable premises. This study took place from April 24 to December 04, 2017 and aimed to assess the current level of the quality of prenatal consultations at the Kadiolo referral health center, to study the structures in place including infrastructure and personnel, to specify the procedures and to determine their results. This work has permitted us to classify the RHC of Kadiolo at level III with 85%, which means that the references evaluated were satisfactory, with the level of 75% to 94%. In terms of structure, a pricing system was deemed affordable by the opinion of pregnant women. The analysis of the level of the human dimension revealed that the health center was level III. The pregnant women were satisfied with the reception which was good in 76% of the cases, as well as with the quality of the respect of the privacy in 96% and confidentiality in 95%. Despite the satisfaction of pregnant women, gaps remain to be filled in concerning the quality of the services received at the Kadiolo referral health center so as to reach level IV.