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Introduction Le lupus erythemateux systemique est rare chez l’homme et son pronostic est souvent grave. Les objectifs de notre etude sont de rapporter l’experience de notre service dans la prise en charge et l’evolution des patients presentant un lupus masculin. Patients et methodes Il s’agit d’une etude retrospective de 25 dossiers de lupus masculin colliges de 2010 a 2015. Resultats L’âge moyen de nos patients etait de 35,56 ans avec un extreme de 15–60 ans. Les manifestations cliniques les plus frequentes etaient cutanees (30 cas) et articulaires (18 cas). Les atteints cardiaques (4 cas de cardiomyopathies dilatees) et renales (4 cas de nephropathie lupique classe IV) etaient les plus pejoratives. Neuf patients presentaient d’autres pathologies auto-immunes (2 cas de polyarthrite rhumatoide, 2 cas de sclerodermie, 2 cas de syndrome de Gougerot Sjogren, 2 cas de syndrome de Sharp et 1 cas de dermatomyosite). L’ anomalie hematologique la plus frequente etait la lymphopenie (15 cas). Les anticorps anti-nucleaires etaient positifs chez 22 patients et les anticorps anti-DNA natif l’etaient chez 18 patients. La corticotherapie etait administree chez tous les patients suivis de 24 cas d’hydroxychloroquine et 16 cas de cyclophosphamide. Quatre patients arrivaient au stade de dialyse. La majorite de nos patients (16 cas) ont bien evolue sous traitement avec un cas de deces. Discussion L’âge moyen de notre etude ne concorde pas avec la litterature. Les atteints pejoratives renale et cardiaque, les autres manifestations clinico-biologiques, les connectivites associees, les modalites therapeutiques et l’evolution de nos patients concordent avec la plupart des donnees de la litterature. Conclusion Le lupus masculin est souvent de mauvais pronostic mais sa prise en charge differe peu de celle de la femme.

Our objectives were to determine the frequency of non-resecable gastric cancers, to analyse its clinical, and therapeutic aspects, and to assess patients follow-up.Our retrospective study has been from 1st January 2008 to 31st December 2009. It included all patients operated or not having non-resecable gastric cancers at general surgery at CHU Gabriel TOUREWe have recorded 305 cases of advanced gastric cancers, accounting for 71.4% of gastric cancers (n=425), 47.8% of digestive cancers (n=766) and 2.2% of hospitalisations. The sex ratio was 1.6 in men favour; the average age was 57 } 12 with extremes of 25 and 90. The average evolution delay was 15.5 months with extremes of 5 and 7, and standard deviation 19.2. 14 patients have been admitted in an emergency context. (8 cases of gastric perforation related peritonitis, 6 cases d’haematemesis). The main found signs were: epigastric tumours 187 (61.3%) cases, lower limbs oedema 105 (34.4%) cases, ascitis 105(34.4%) cases, hepatomegaly 68(22.3%), lymphadenopathy ≪ ganglions de Troisier ≫21(7%), ≪ ecailles de Brumer ≫ (= Brumer’s scales) from rectal touch 17(6%) cases More than half of patients have been classified ASA 4.105(34.4%) ASA 5, and 74(24.2%) ASA . The tumour location was antrum in 260(85.2%) cases Cardiac orifice in 17(5.5%) cases, fundus i n 11(3.6%), the gastric linitis in 17(5,5%) cases. The imaging has found the ascitis in 119(39%) cases, the hepatic metastases in 54(17.7%) cases, pulmonary in 36(19%) cases, pancreatic 5(1.6%) cases, splenic in 4(1.3%), and ovarian in 3(1%) cases 105(34.4%) patients had no surgery, 4(1.3%) had chemotherapy, and 200(65 %) had surgery. The mortality rate was at 16.5% and the one year survival at 15.5%.

The foreign bodies of the oesophagus see each other at any age. They are more frequent at the child's than at the adult. The cutting foreign bodies can constitute an urgency because of the risk of oesophagienne perforing or bleeding.Bring report the epidemiological and clinical profile of the foreign bodies of the oesophagus in our practice, and underline the difficulties of coverage(care) at the adult.A forward-looking study was realized of April, 2007 in Mars 2009 in the service ENT of the University hospital (CHU) Gabriel TOURE of Bamako concerning 26 grown-up patients presenting a foreign body of the oesophagus.Both sexes are affected in a equivalent way. The average age was of 32 years with extremes of 15 years and 65 years. The patients from 31 to 45 years old were the most touched. The false tooth was the foreign body most frequently met (58 %). Three patients presented complications has type of oesophagienne perforing (2) and of oeso-trachéale fistula (1) the outcome of which was fatal afterward. The oesophagoscopie in the stiff tube under general anesthesia allowed to extract 92 % of the foreign bodies.The foreign body of the oesophagus is a pathology so frequent at the adult and the diagnosis is mostly evident. Among the foreign bodies, false teeth raised problems of therapeutic coverage. The prevention passes by the regular medical supervision of false teeth, the training formation of the staff, the improvement of the technical trayp, and a good education of the patient.

The admission of a patient in intensive care justified by the severity of the disease, is a stressful situation for his heirs. A fair and understandable information is a major component of the process quality of care.Evaluate the practice of informing families of patients and their satisfaction in intensive care unit.We conducted a prospective study of 90 families of patients. The demographics of family representatives, and satisfaction data were collected.The majority of parents were aged between 20-40. The sex ratio was 2.9 for men. The siblings had accounted for 23 parents whether 25,6%. In 46 cases whether 51%, the relatives of families were satisfied with information received. 57.8% did not have good information on the risks of treatment complications. The lack of explanation about the evolution of the disease remained a major concern for 36 families. 69 of parents whether 76.7% felt that the frequency of visits was satisfactory. In our series no contradiction has been recorded in the information provided in 87 (96.7%) parents of patients. 80 (88.9%) of parents of patients showed the courtesy of staff at the reception. 54 relatives of patients whether 60% said they could not have been involved in the therapeutic management of the patient. 41 parents of patients whether 45.6% do not differentiate between the role of different caregivers. 45 parents felt uncomfortable.Despite the lack of normative information , most family members of patients were very satisfied with the information they were provided. Efforts to improve the satisfaction of families go through identifying the needs of the latter and effective communication strategy.

Diabetes complications constitute the 2nd cause of amputations after the sequels of traditional treatment for traumatism of the members with negative functional, aesthetic and psychological effect. The aims of this study were to determine the prevalence of the amputations consecutive to the complications of the diabetes, and describe the operating suites and the type of used equipment.20 cases of amputations consecutive to the complications of the diabetes (ACCD), from October 1st, 2006 to September 30th, 2007 in Nianankoro Fomba hospital of Segou.The frequency was of all the amputations with mean age of 57 years and sex-Ratio 1, 87. A history of high blood pressure was found in 18 cases (90%), the notion of addiction to smoking in 4 cases (20%). 7 (35%) patients had a body mass index included between 25 and 30 kg/m2 and 15 (75%) were of typical diabetes II. The average duration of evolution was included between 5 and 9 years. The leg and the foot was the most frequent seats 15 cases (75%). The state 5 of Wagner was the most frequent 12 cases (60%), and a glycaemia included between 3 and 4.99 g/l in 12 cases (60 %). The staphylococcus was the most frequently found germ in our taking, 12 cases (60%). The leg was the level of amputation the most frequent 35% (7 cases). 15 (75%) patients had a favourable evolution. We recorded 5 cases (15%) of death. The crutch was the locomotion's apparatus the most used in 11 cases (55%)An earlier management of diabetes will avoid these complications.

The incisional hernia is a frequent complication of the opened abdominal surgery. The objectives of this study were to determine the hospital frequency and the favoritizing factors, to analyze the therapeutic aspects.We realized a retrospective study from January, 1999 to December, 2005 in the services of general and paediatric surgery of teaching hospital Gabriel Touré. It concerned 45 cases of incisional hernia. The hernias of the abdominal wall, the abdominal and traumatic hernia were not retained.The frequency was 0.52%; the average age of our patients was 37.8 years with a sex ratio of 2 in favour of the woman. The average delay of consultation was of 59 months with extremes going from 2 to 11 months. Favoritizing factors found were the parietal suppuration to 13 (28.8%) patients and the multiple interventions to 8 (17.8%) patients. The average dimension of the hernia was 9.5 cms ± 3.8 with extremes going from 5 to 14 cms. The 45 patients benefited from the cure of the hernia according to Mayo. We didn't lost any patient. 2 parietal suppurations happened post-operatively.Incisional hernia treatment consists for Mayo's method or prosthesis. The laparoscopic surgery can reduce complications.

Evaluate the care of burn sequel of the hand in the services of orthopaedic trauma and paediatric in the teaching hospital Gabriel Touré.It was about a longitudinal and prospective study lasting from Jun 2006 to January 2008 in all the children aged from 0 to 14 years with burn sequel of the hand admitted and treated in the services of orthopaedic- trauma and paediatric surgery of Gabriel Touré. Patients with an incomplete file or lost during the study were not included.In 20 months we brought together 40 cases of burn sequel of hand. The mean age of the patients was 8.5 years. There were 18 boys and 22 girls. The sex-ratio was 1.22 for girls. The causal agent was more frequently thermal (85%) by hot liquid. Burn was caused by domestic accident in 95%. 14 of our patients were seen by a doctor after 24 months of burn and another 14 were after 36 months. A functional deficit was noted to the physical examination in all our patients. The treatment was surgical in 26 patients. Results were judged well in 16 cases, little good in 8 and bad 2 case. A good initial treatment done in a fear condition permit to reduce the number of sequel of the hand and to stay less severe.

Describe the severity of bone lesion and evaluate the results of the treatment of osteomyelitis in patients with sickle cell disease.It was about a prospective study done from December 2005 to November 2006 in patients with confirmed sickle cell admitted for osteomyelitis.We gather together 62 cases of osteomyelitis in sickle cell disease among 120 cases, which was about 51.7%. The mean age has been 17 years. The diagnosis was made on biology and x rays. 46.78% of our patients were sickle cell homozygote. Bone pain was the 1st reason of consultation with 53.2% of cases. Staphylococcus aureus and salmonella were the most frequent germs, with 43.55% each. Complications were noted in 32.26% because of diagnosis delay (P 0.05). Delay in the management or incorrect treatment can result in a severe and definitive sequel for the functional future of those patients.

Were to determine the frequency, to describe the clinical and therapeutic aspects digestive stoma.It was about six months an exploratory study from January 1st to June 30th, 2008 in the department of surgery general of the CHU Gabriel Touré. Were included in this study all the patients carrying a enter stoma or a colostomy, old of more than 15 ans. The digestive dents, the other types of stoma and the patients old of less than 15 years, were excluded. The results were analyzed by the software Epi information version 6.4 Fr, the tests of Khi 2 and Student with a threshold of significance for P0.05.We college 32 patients are 7.4% of all digestive surgical operations, 13.3% of the abdominal urgencies; composed of 26 men (81.25%) and 6 women (18.75%). The sex ratio at summer of 4.3. The average age was 44, 8 years with a standard deviation 8, 13 and the extremes varying between 16-80 years. Twenty and one (65.6%) sick were operated in urgency. We carried out 29 cases (90.6%) of final stoma, 3 cas (9.4%) side, 21 cas (65.6%) of colostomy, 9 cas (28.1%) of ileostomies. They were temporary in 25 cas (78.1%) and final 7 cas (21.9%). The volvulus of the sigmoid colonist with necroses 10 cas (31.3%), the peritonitis by typhus perforation ilea 9 cas (28.1%), occlusions on tumor of the left colonist 8 cas (25%), the traumatic perforations ileales 2 cas (6.3%), the digestive dents post appendicectomies 2 cas (6.3%) and the congenital megacolon 1 cas (3%) was the indications of the stoma. the operational continuations were simple in 21 cas (65.6%). The principal found complications were: coetaneous irritation 7 cas (21.8%), the prolapsed stomiale 4 cas (12.5%), the suppuration peristomial 3 cas (9.4%), the releasing of Stoma 3 cas (9.4%), the retraction of the stoma 3 cas (9.4%),the psychological disorders 3 cases (9.4%), the hemorrhage 2 cas (6.3), necroses peristomial 2 cas (3.1%), septic shock 2 cas (6.3%), and 1 cas (3.1%) of evisceration, obstruction of the bowels, shock hypovolemic. The intermediate duration of hospitalization was of 37,5 jours with a standard deviation = 13.58 and extremes varying between 02-73 days. Death rate was of 9.4%.The assumption of responsibility of the stomies is difficult in the absence of stomatherapeutes, and of the high cost of the parenteral nutrition in our context .

the omphalocèle is an evolution of the extra embryonic coulombs between the 32th and the 72th days of the pregnancy. The treatment depends on his volume. In Mali; few works were published on the omphalocèle and its treatment.we brought together 111 cases of omphalocèles during 8 years of study with the aim of determining the epidemiological factors and describing the clinical and therapeutic aspects.49 patients on 111 were of the male and aged between 4,2 days with weight between 2500 - 3500 g. The diameter of the r snare was superior to 8 cms in 29(26,13%) cases and has benefited a conservative treatment according to Grobb. 13 patients had a rupture of the membrane. The liver has been found in 29 time (26,13%) in the sac and 35 case and associated malformation. 20 cases of death have been observed. Antenatal ultrasound found exomphalos in 9 cases. Any mother had a story of teratogenic medications and 67 mothers were multipared.Omphaloceles are multidiscipli-nary surgical emergencies. Antenatal echogra-phy is useful for the antenatal diagnosis.

The occurrence of an event planned or unplanned during anesthesia is a concern for staff. This event may jeopardize the success of surgery gesture. Pediatric Surgery therefore has its own specific complications that it requires anesthesia.To evaluate the incidence of adverse events during anesthesia in pediatric surgery scheduled.Descriptive non-randomized study.Descriptive non-randomized study on adverse events related to anesthesia in children over a period of seven months. It took place in the anesthesia and intensive care unit and the pediatric surgery unit of Gabriel Toure hospital in Bamako. It focused on patients aged 0 to 12 years scheduled for surgery under general anesthesia during the study period.Sixty six percent of patients selected was male gender with a sex ratio of 3 in favor of males. The average age was 2 years with extremes of 16 days and 12 years and a standard deviation of 2.93. The old history of premature was found in 36% of patients and 2% of asthmatic. The number of patients experiencing an adverse event is 42 on a total of 107 patients collected either 39.25%. When the children were younger than one year adverse events occurred with 30, 76%. The occurrence of adverse events was more frequent when the child was not intubated with P0.05. All adverse events have received support except tachycardia, late revival but all developed positively.This study estimates the incidence of adverse events in anesthesia during pediatric surgery. The overall rate of patients experiencing an adverse event is relatively high. Children age less than or equal to one year are most vulnerable.

A six-month prospective surveillance study of postoperative surgical site infections (SSIs) was undertaken between January and June 2010 in paediatric patients aged15 years, in the University Hospital Gabriel Touré, Mali. SSI was documented in 43 out of 352 children (12.2%). SSIs were significantly more common after emergency operations, in patients with a National Nosocomial Infection Surveillance System (NNISS) score of 2 or 3, and in patients operated on by trainee rather than by experienced surgeons. Children with anaemia or malnutrition were significantly more likely to develop infection postoperatively. Patients' sex, duration of preoperative stay and the number of patients in the hospital room were not considered as risk factors for infection (P0.05).

Introduction L’infection par le VIH est le developpement du virus dans l’organisme de l’homme. Elle est caracterisee par la destruction progressive des lymphocytes CD4 responsable d’une defaillance immunitaire favorisant ainsi le developpement d’infections opportunistes graves et des tumeurs. En guinee l’epidemie est generalisee avec un taux de prevalence de la population adulte estime a 1,5 %. L’objectif de cette etude etait de decrire les profils epidemiologiques, cliniques, therapeutiques et evolutifs des malades infectes par le VIH hospitalises dans le service dermatologie-MST du CHU de Conakry. Patients et methodes Etude retrospective de type descriptif menee de 2000 a 2010 a partir des dossiers d’hospitalisation dans le service de dermatologie-MST du CHU de Conakry. Tous les dossiers de malades hospitalisees pour prise en charge de l’infection par le VIH ont ete inclus. La collecte des donnees a ete faite a partir d’une fiche d’enquete prealablement etablie. Les variables collectees etaient : la frequence, les donnees demographiques habituelles (âge, sexe, profession, situation matrimoniale, domicile habituel) les infections opportunistes, les stades de l’infection par le VIH selon OMS, l’association antiretrovirale utilisee et l’issue de la maladie. Resultats Nous avons collige 804 cas (35,12 %) d’infection par le VIH sur un effectif de 2289 malades hospitalises. Il s’agit de 423 femmes et 381 hommes, tous infectes par le VIH1 (98,02 %) et le VIH dual (1,98 %). L’âge moyen etait de 37,14 ± 0,10. Les maries etaient plus touches (57,34 %) avec une predominance du regime polygame (33,70 %). La duree moyenne de sejour etait de 14,31 ± 0,09 jours. Les infections opportunistes etaient dominees par la candidose oropharyngee (45,39 %), la tuberculose pulmonaire (20,77 %), la gastro-enterite (16,92 %) et la maladie de Kaposi (15,92 %). Quarante-neuf pour cent et 33,58 % des malades etaient respectivement aux stades III et IV de l’OMS avec des CD4 3 . Plus de la moitie des malades (66,20 %) presentaient au moins deux infections opportunistes associees. Quatre-vingt-douze pour cent des malades etaient sous traitement de premiere ligne a base de zidovudine, lamivudine et Nevirapine. L’evolution etait marquee par un taux de deces de 31,84 %. Discussion Avec 35 % de cas d’infection par le VIH parmi les malades hospitalises, notre etude prouve qu’en Guinee l’epidemie du VIH est generalisee. le retard diagnostic explique l’importance des infections opportunistes. Les caracteristiques epidemiologiques, cliniques, therapeutiques evolutives decrites chez nos malades sont proches de celles rapportees par la plupart des auteurs. Conclusion Malgre les campagnes de sensibilisation, la disponibilite et la gratuite des antiretroviraux, la prevalence hospitaliere de l’infection par le VIH et la mortalite restent encore elevees.

Introduction La mortalite et la morbidite constituent deux importants indicateurs de sante publique. Les objectifs de cette etude etaient de determiner la prevalence des dermatoses en hospitalisation, decrire le profil demographique des malades, Identifier les principales affections hospitalieres et determiner le taux de mortalite hospitaliere liee aux differentes affections. Patients et methodes Il s’agissait d’une etude retrospective de type descriptif menee de janvier 2000 a decembre 2009 a partir des dossiers de malades hospitalises dans le service de dermatologie-MST du Centre hospitalier universitaire de Conakry. Ont ete inclus dans cette etude tous les dossiers de malades hospitalises pour affections dermatologiques quel que soient l’âge, le sexe et l’origine. La collecte des donnees a ete faite a l’aide d’une fiche d’enquete prealablement etablie. Les variables etudiees etaient l’âge, le sexe, la duree moyenne de sejour, les dermatoses en hospitalisation, l’evolution, le diagnostic au moment du deces. Resultats Au cours de cette etude 2056 malades ont ete hospitalises dont 1463 cas de dermatoses (71,10 %). L’âge moyen des malades etait de 29,27 ans et le sex-ratio de 0,74 en faveur des femmes. La duree moyenne de sejour etait de 13 jours. Les affections les plus frequentes etaient les dermatoses bacteriennes avec au premier plan l’erysipele (32,53 %) et la fasciite necrosante (15,51 %), les maladies allergiques (9,68 %) et la maladie de kaposi (9,15 %). Les dermatoses etaient souvent associees a l’hypertension arterielle (19,89 %) et au diabete (2,29 %). Selon l’evolution, 89 % des malades sont sortis ameliores et 7,90 % sont decedes. Les diagnostics au moment des deces etaient domines par la maladie de kaposi (40,50 %) et la fasciite necrosante (18,10 %). Discussion La morbidite hospitaliere restant dominee par les dermatoses infectieuses serait liee aux conditions socio-economiques mediocres. Tandis que la mortalite elevee chez les malades hospitalises pour maladie de kaposi epidemique explique l’importance de cette affection au sein des infections opportunistes. Les caracteristiques cliniques et epidemiologiques decrites dans cette etude sont proches de celles rapportees par la plupart des auteurs. Conclusion L’etude a permis d’etablir le repertoire des dermatoses en hospitalisation et la mortalite liee a aux differentes affections.

Le lymphome de Burkitt dans sa forme Africaine peut se manifester sous des signes d’emprunt ORL a type de tumefaction orbito-maxillo-faciale. Le diagnostic peut etre fait par les ORL a travers un faisceau de signes cliniques et une cytoponction. La prise en charge se fait dans des unites d’oncologie medicale ou le bilan d’extension et le lancement de la chimiotherapie sont des imperatifs incontournables. Actuellement cette tumeur a potentiel tres agressif repond a une poly chimiotherapie bien conduite. Mots-cles : Lymphome de Burkitt, cancer, voies aerodigestives superieures, oncologie pediatrique

This prospective descriptive study was carried out from August 2007 to January 2008 in the emergency surgery department of Gabriel Touré Hospital in Bamako, Mali. A series of 184 patients treated for head and neck injuries was compiled. Patients presenting strictly neurosurgical lesions were excluded. Most of the patients included in this series were young single city-dwelling males (mean, age, 27 years; M/F sex ratio, 4.3. Most injuries were sustained in road traffic accidents (93%). The most common injuries were epistaxis and multiple fractures of facial bones, cervical spine and petrosal bone. These injuries ere often associated with avulsive wounds involving the external ear and nose. The main complication risks fell into four categories, i.e., circulatory loss, upper airway obstruction, functional and/or morphological impairment, and coma-related death (Glasgow score8). Shortage of medication and/or disposable treatment kits was a major handicap for optimal management of head and neck injuries.

This work presents the results of the behavioural and serologic survey on HIV/AIDS conducted from December 2007 to December 2008 among the group of STD (sexually transmitted disease) patients, supposed to be at HIV infection risk. In Mauritania, the last survey of HIV seroprevalence among the STD patients goes up to the year 1995 (the prevalence was estimated then to be 0.9%). The goal was to determine the seroprevalence of HIV and syphilis and to gather information on the knowledge, the sexual behaviours on a risk concerning the HIV/AIDS, and the sexually transmitted disease among these patients. The census has been made on over 224 STD patients during the period of the study, without predominance of sex and with a majority of young adults. The prevalence for HIV is 9% and for the syphilis it is 10%. Actually, the condom is widely underused by this group, even in occasional intercourse. The STD patients are a group of risk towards HIV, because of their risk behaviours and low level of knowledge.

This work reports the results of one year (November 2004-October 2005) descriptive study of tumours located in the head and neck areas in the ENT department of the University-Hospital of Gabriel Toure in Bamako. Were included in the study patients whose files showed epidemiology data: age, sex, profession, residence and period of the medical checking, and exposition factors: anatomic location, results of histology and image data of the tumours. Where excluded from the study the patients whose file were not completed and those that have had eye and brain tumours From the data base of the department, a total of 60 cases of tumours were monitored and 25 others cases were excluded according to the criteria. Among the 60 cases, 24 tumours (40%) were malign and 36 were benign. Goiter was the most found benign tumor according to the results of the hystology analysis. In most cases (15 out of 36, 41.67%) the histology analysis showed an colloid adenoma Other rare tumors like rhinoscleroma (5 cases out of 36, 13.89%), nose invertus papilloma (2 cases out of 36, 5.55%) where found. These were easily diagnosed and treated. In the group of malign tumors, the pharyngolaryngeal cancer was the most found (11 cases out of 24) and the most predominant histology of these cancers was the epidermoid carcinoma. Two of these cancers were found in patients below fifteen years of age, but no other risk factors like expositions was noted in the files of these two patients. Other malign tumors have been found: nose and sinusal cancers and thyroid carcinoma. In most cases these tumors were diagnosed at an advanced stage.

Diagnosis and therapeutic of foreign bodies of the oropharynx are not difficult in general. The diagnosis is usually obvious for the adult. We report a case of foreign body of the oropharynx observed in a patient, psychologically stable, which occurred two months after a traumatism. The patient was not aware of the existence of the foreign body. It was extracted two months after the accident by endo-oral track under general anaesthesia. The nature of the foreign body, the fortuity of its discovery and its presence for a long time reported here are of interest.

Establish the frequency of osteoarthritis in our service an establish an adequate therapeutic protocol.It is about a retro and prospective study realised from January 2001 till January 2004 on all the 0 to 15 years old children treated and followed in the service for osteoarthritis. Ten patients having no complete file or having disappeared during the study were excluded.41 cases of osteoarthritis brought together in 26 boys and 15 girls. It occupied 0.8% of the hospitalization and 1.14% of the surgical activities. The average age of our patients was of 4.58 years+/-4.41 with extremes going from 0 to 15 years old. The noted facilitating factor was sickle cell disease (70.7%). The hip was the most affected articulation (48.8%). The staphylococcus was the most met germ (48.8%).A meticulous examination of a child presenting an articular pain and its management within a better time are necessary to avoid the frequent invalidating sequel in our country.

Evaluate the efficiency of the treatment of pain by analgesic according to World Health Organization (WHO).We made a descriptive and analytic study in majors sickellers in pain crisis admitted in the service of paediatric of the hospital Gabriel Touré Bamako from January 2005 to January 2006. The efficiency of the treatment by painkiller was evaluated at second hour and at the 24 hour.Our study concerned 70 children with major of sickle cell of both sexes and aged from 6 to 15 years in pain crisis. In 87.1% pain disappeared with painkillers palier I (paracetamol) and 12.9% had necessitated to pass to palier II (buprenorphine) an 64.3% our patients the pain disappeared in a period less than 12 hours with an average of 3 hours against only 35.7% soothed in a period more than 12 hours with average of 64 hours 3 minutes. Pain from the head and limbal region were the most sensible to the treatment.The treatment of pain by palier according to who is efficient in children sickeller.

Evaluate the epidemio-clinical and therapeutic aspects of the femur's fracture of the child.It was about a prospective study done from October 1st, 2005 to September 30, 2006 on all children of 0 to 15 years old admitted for femur fracture, treated and followed in the trauma center of hôpital Gabriel Touré. Disappeared patients have not been included.We brought together during a period of 12 months 47 cases of fracture in 45 children representing 26 % of the activities of trauma unit of hôpital Gabriel Touré. Among our patients 25 were boys and 20 girls. The average age was 7.5 yeras +/-4. The public highway accident was the first cause (68.8%) followed by domestic accident (22.2%), sportive (6.6%), obstetrical (2.2%). The treatment was orthopaedic in 52.17% and surgical in 47.83%. Complications were the following: residual pain in 6.6%, length disparity of the limbs in 4.4%, secondary slipping in 2.2% and hypertrophic callus in 2.2%. P0.05. The results were good in 71.7 % of the cases, passable in 24 % and bad in 4.3% of the cases.Femur fracture is a frequent affection by which the first cause remains the public highway accident.

Burkitt's lymphoma was first described in Africa where it remains one of the most common malignant tumors in children. To our knowledge there have been no large series describing Burkitt's lymphoma involving the maxillofacial area or any other location in Malian children. The purpose of this retrospective single-center study was to describe clinical, laboratory, and therapeutic findings in children treated for maxillofacial Burkitt's lymphoma in the Oncology Unit of the Gabriel Touré Pediatric Hospital in Bamako, Mali from January to December 2006. A total of 38 cases of Burkitt's lymphoma were diagnosed during the study period. This series includes 24 children (63.2%) under the age of 15 years in whom diagnosis of previously untreated maxillofacial Burkitt's lymphoma was confirmed by cytology. All patients were treated using the GFA 2005 protocol for Burkitt's lymphoma. There were 17 boys and 7 girls (sex ratio of 2.4). In all cases the disease was advanced, i.e. stage III in 87.5% and stage IV in 12.5%. Following three cycles of Endoxan in association with 3 injections of metothrexate and hydrocortisone, complete remission was observed in 37.5% and 16.6% were lost from follow-up. Treatment complications after 6 cycles included hematologic toxicity in 71.5% and alopecia in 100%. Most patients (70.8%.) presented no infectious episode. Follow-up examination at one year showed that 29.2% of patients remained in complete remission. Despite limited resources for treatment and surveillance, the survival rate in our series of patients treated for advanced stage Burkitt's lymphoma was about 30%. It is likely that a strategy based on an information campaign to enhance the awareness and knowledge of parents, training of medical and paramedical staff, and improvement of management facilities could further reduce mortality due to Burkitt's lymphoma in Malian children.

The accidental intoxications constitute more and more a serious problem among young children in the developing countries because of their frequency and difficulties for taking care of those victims. The objective of our work was to study acute intoxications among children in order to determine the frequency, to identify the products in question and to determine the impact of those accidents in the future life of the victims. The study was carried out in the Paediatric Service of the CHU Gabriel Touré from January 2001 to June 2002. We enrolled 89 children from 0 to 15 years of age. Information on our patients was recorded on investigational questionnaire and completed with data from their entry and hospitalization records. Among 8237 children hospitalized during the study period, 89 of them had acute intoxication i.e. 1.08%. Children less than five years of age were more frequent with 85.4% with a male prevalence of 61.8%. Antimalarial drugs and petroleum were the most accused products. Administration of milk and provoked vomiting were the attitudes and practices of the entourage of the victims when intoxication occurs. The evolution was favourable in 67.2% of the cases with a hospital lethality of 13.7%.

Summary The urethral duplication in the child is has very rare congenital malformation which is more often seen At the servant boy many anatomical forms are described. The authors carryforward has box of urethral duplication one-eved with constitution of has mass will will intra scotale taking the form of one 2nd testicle At has 7 year old servant boy. The clinical observation, radiological investigation, and the treatment are described.

DRANK: The goal of this work is to determine the factors of surgical mortality in period neonatal and to emphasize the difficulties of the assumption of responsibility.Retrospective study of 222 cases over 10 years from January 1992 to December 00 realized in the service of Paediatric surgery of the National Hospital Donka. We studied the age of the patients to the first consultation according to whether it is received before or after the 6th day of birth, the socio-economic level was appreciated according to the mode of dwelling, accessibility with drinking water and electricity, the diet, associated malformations, the postoperative results.In 10 years (January 1992 at December 2001), we recorded 222 surgical cases of newborn emergency interesting the digestive tract (27.48%), the abdominal wall (37.39%), the parts urogenital (2.25%) and neurological (32.88%). We noted a male prevalence of 64.41% and surgical newborn mortality was 29.28%. The delay with the consultation, poverty on the one hand and the lack of the means of reanimation, the insufficiency of qualified personnel, were the principal factors of risk in our series.The surgical newborn urgencies gather affections which require an immediate and adequate assumption of responsibility. The early diagnosis is a requirement; it must be done in the room of childbirth. The childbirth in residence, the ignorance of these affections by much of experts involves the delay with the consultation. The insufficiency of personnel qualified in paediatric surgery and infantile anaesthesia-reanimation, the poverty of the parents who must deal with the medical expenses of the new-born babies are as many factors which delay the time of intervention. The training of the specialists in paediatric anaesthesia-reanimation, the formation continues agents of health on all the levels on the tracking of the newborn urgencies, the creation of the centers of reanimation, the motivation of the personnel looking after in these structures and the intervention of the medical O.N.G. will be major assets to improve the assumption of responsibility and to decrease the death rate.

Most newborn deaths are associated with birth asphyxia (40%), low birth weigt and prematurity (25%) and infections (20%). In Mali, in the Community Health Centers (CSCOM) exercises a staff composed of the nurse chief of health centers (ICPM) assuring the supervision of the matrons that is charged in pregnancy and the newborn. An investigation KAP (Knowledge, Attitudes and Practises) initiated in order to assess the knowledge and the practices of the community health centers agents on birth asphyxia. The survey was cross-sectional and that took place in September 2004. Have been included in the study the matrons, the nurse chief available at the time of the survey. The multiplicity of the names mentioned among which Ninakili dégou (27,3%) and Niominè (15,2%) are the most frequent and show the necessity of a qualitative investigation to find a name. Prolonged labor more than 12 hours (73,3%) and the stained amniotic liquid (63,3%) are the most recognized signs during labor making fear the birth asphyxia. In our survey the prolonged labor (63,7%), the infection/malaria of mother (60,7%) and the Dystocic delivery (45,5%) were the mostly reported causes of birth asphyxia. The pale or bluish coloration (69,7%), the irregular or lack of breath (69,7%), the lack of cry (63,6%) were known as the main signs of birth asphyxia. We noted some good practices as aspirating with a bulb (69,7%) and clearing upper ways with a finger covered with gauze (30,3% ); doing the mouth to mouth (51,5%); stimulating the newborn (66,7%). The improvement of the neontatal mortality requires the training of the staff and the equipment of the centers in small simple materials of resuscitation.

In most developing countries, bacterial meningitis (BM) is associated with a high case-fatality rate. The search for a simple, convenient, and inexpensive antibiotic treatment remains a priority. In this study, a non-blinded, multicentre, randomised clinical trial of 528 cases of BM was done in two hospitals in Mali and Niger, between March, 1989, and May, 1990, to see whether a double injection of long-acting chloramphenicol (on admission to hospital and 48 h later) is as effective as a course of intravenous ampicillin (8 days, 4 times a day). The cumulative case-fatality rate on day 4 (principal end-point) among the chloramphenicol (254 patients) and ampicillin (274) groups were, respectively, 28% and 24·5% (relative risk 1·14, 95% confidence interval 0·86-1·52). No outbreak occurred during the study period. The hospital case-fatality rate was 33·1%. Main risk factors for death were associated with clinical condition on admission—ie, altered consciousness, convulsions, or dehydration. The case-fatality rates were 13% (21/1 61) for Neisseria meningitidis, 36·1% (48/133) for Haemophilus influenzae , and 67% (77/115) for Streptococcus pneumoniae. In a multiple logistic regression model, controlling for the differential distribution of potential risk factors (including bacterial species), there was no difference between treatment groups. Our findings suggest that long-acting chloramphenicol is a useful first-line presumptive treatment for BM in high-incidence countries.

Laparoscopic surgery is now a widely accepted modality for gastrointestinal surgery. In this report the authors evaluate their four-year experience with laparoscopic surgery in a total of 494 patients in Abidjan, Ivory Coast. Cholecystectomy and appendectomy were the main indications in this series. However laparoscopic surgery has a wide range of applications in Black Africa not only for elective indications such as evaluation of chronic abdominal pain and digestive cancer but also emergency indications such as peritonitis and abdominal trauma.

International audience; BACKGROUND:The population exposed to malaria within African cities has steadily increased. However, comprehensive data on life-threatening malaria features and risk factors in children from urban areas with seasonal malaria transmission, such as in Bamako (Mali), are lacking.METHODS:Children admitted to the Gabriel Touré Hospital in Bamako with severe malarial anemia (SMA) and/or cerebral malaria (CM) were prospectively included in the study. Indicators of either SMA or CM were analyzed using logistic regression; and death hazard ratios (HRs) were estimated through survival analysis.RESULTS:The study included 455 children: 66% presented with CM, 34% with SMA, 3% with hypoglycemia (HG); 5% with dehydration; 17% with respiratory distress (RD); 25% with splenomegaly; and 92% with hepatomegaly. The children with CM were older than those with SMA. CM was more often associated with dehydration, HG, and RD, whereas SMA was more often associated with splenomegaly. The overall case fatality rate was 16%, and 94% of the children who died had CM. HG [HR: 2.37; 95% confidence interval (CI): 1.04-5.39; P = 0.040], RD (HR: 4.23; 95% CI: 2.46-7.30; P < 10(-6)) and a deep coma with a Blantyre score of less than 3 (HR: 6.78, 95% CI: 2.43-18.91; P < 10(-3)), were all independent predictors of death.CONCLUSIONS:These findings delineate the patterns of severe malaria in children in a West African mesoendemic urban setting. They validate practicable prognostic indicators of life-threatening malaria for use in the limited facilities available in African health centers and provide a frame of reference for further research addressing life-threatening malaria in this setting.

The role of the Th1 pathway in the pathogenesis of severe malaria is unclear. We recently reported that a polymorphism with increasing IFNG transcription is associated with protection against cerebral malaria (CM). Interleukin-12 is required for Th1 cell differentiation, which is characterized by the production of interferon-gamma. We investigated 21 markers in IL12-related genes, including IL12A and IL12B encoding the two IL-12 (IL12p70) subunits, IL12p35 and IL12p40. We performed a family-based association study using a total sample set of 240 nuclear families. The IL12Bpro polymorphism was associated with susceptibility to CM. The CTCTAA allele and the GC/CTCTAA genotype are over-transmitted to children with CM (P = 0.0002 and 0.00002, respectively). We estimated the odds ratio to be 2.11 for risk of CM in heterozygous children [(95% confidence interval, 1.49-2.99); P < 0.0001]. Although the CTCTAA allele had a dominant effect on CM susceptibility, this effect is much stronger in heterozygous children, consistent with the functional effects of this allele in a heterozygous form. Heterozygosity for this polymorphism has been associated with reduced expression of the gene encoding IL12p40 and a low level of IL12p70 production. These results, together with the findings from immunological studies of low interferon-gamma and IL-12 levels in CM, support a protective role for the Th1 pathway in CM.

Throughout this chapter, the author plays with the international aspects of the political economy of health care in Senegal. Within the context of a political economic history, underdevelopment theory—and of course, development theory—relies heavily on the argument of intervening powers from beyond the borders of the given nation-state to illustrate the ways in which both international and national class interests combine to promote dependency in the “underdeveloped” state. In the case of Senegal, certainly the notions of “center-periphery” dynamics can be extended and illustrated. Yet, even here, they, along with terms like “dependency,” “development”/“underdevelopment,” and even “independence” need to be redefined and re-contextualized. The chapter addresses dynamics of international intervention in Senegal and brings together examples of, and allusions to that intervention that are cited throughout the work. It also highlights “deviant” activity—activity that moves in contrast— in opposition—to conventional definitions.Keywords: deviant activity; health care; independence; international intervention; political economy; Senegal; underdevelopment theory

Sex is legal in Senegal. As an industry, it is recognized and regulated. Its regulation has become a central instrument for calibrating sexually transmitted diseases, educating the public about them, and then in controlling and eradicating them. All this is achieved through the agency of its women workers—“prostitutes.” They too, are an essential and conspicuous element in the army Senegal has assembled to combat HIV/AIDS. The critical role assigned to these women in this health care struggle helps to re-contextualize and then to unpack the politically and culturally-laden implications of a term such as “prostitute.” That recontextualization and analysis also force a re-evaluation of gendered constructions, and this also implies the need to critically examine the role of women within the general political economy, and within the political economy of health care in Senegal, specifically.Keywords: AIDS; health care; HIV; political economy; prostitutes; Senegal; sexually transmitted diseases; women workers

Political economic entities have historical legacies that are shaped by both internal and external activities. In many cases, the colonial experience provided the basis for the improvement of health care in the metropolitan center. Health care systems, from the colonial period through the present, placed emphasis on class, race, and gender, as well as the economics, and the geography of the systems. An analysis of postcolonial Africa indicates that imperialism did help to define emerging institutions and did help to restrict their growth as well as their range of possible alternatives. Because of this, one approach to understanding the implications of this is an assessment of the material basis of Africa’s historical development and its relation to the evolution of health care. Under these circumstances, one of the best ways to examine health care as a political economic entity is within the framework of imperialism.Keywords: Africa’s historical development; colonial experience; health care; imperialism; metropolitan center; political economic entity; postcolonial Africa

The context provided by a political economic history sheds light on the commoditization and commercialization of health care and the dynamic processes of integration of the traditional, the Islamic, and the western health care sectors. A political economic history of health care in Africa provides an overview that speaks to contention and competition that can be read through an examination of systems of health care and their interaction at the level of general political economy. The imposition of the powers of the state and their maintenance through the health care apparatus— colonial, or otherwise—can be witnessed in the struggle for health care itself. Various systems of health care have evolved in Africa within their own very specific socio-political economic contexts. There are several implications concerning the political economic nature of health care in precolonial Africa. Traditional practitioners, as individuals and as a class, acquired a “privileged” position in their communities.Keywords: Africa; commercialization; commoditization; health care; political economic history; traditional practitioners

Introduction Les prisonniers sont une population defavorisee et vulnerable. On sait peu de choses sur leur etat de sante en Afrique subsaharienne, et aucune description centree sur les affections dermatologiques en milieu carceral n’est disponible en Guinee. Le but de cette etude etait donc de fournir une description detaillee des affections dermatologiques presentees par les detenus et d’en determiner les facteurs determinants dans le plus grand centre de detention de la Guinee. Materiel et methodes Ce travail a eu pour cadre la maison centrale de Conakry. C’est un etablissement penitencier edifie au debut du 20e siecle pour une capacite d’accueil theorique de trois cents personnes. Son taux d’occupation en 2013 etait de 377 % ce qui reflete une saturation. Nous y avons realise du 1er au 17 avril 2013, une etude transversale descriptive et analytique ayant inclus tous les detenus presentant une ou plusieurs dermatoses et ayant accepte de participer a l’etude. Pour chaque detenu, les differents types de dermatoses etaient identifies. La frequence de la douche, l’utilisation du savon pour la douche, le changement d’habits et l’assainissement des cellules etaient analyses par le Chi2 de Pearson au seuil de 5 %. L’etude etait autorisee par les autorites penitentiaires. Resultats Mille cent trente et un detenus ont ete examines ; 320 presentaient des dermatoses soit une prevalence de 27,3 %. Il s’agissait de 292 hommes et 28 femmes soit un sex-ratio de 10,42. La moyenne d’âge etait de 30 ans avec des extremes de 15 et 70 ans. Les dermatoses infectieuses etaient les plus representees avec 247 cas (77,2 %) avec une predominance de la gale notee chez 146 detenus, de dermatophytoses notees chez 58 detenus. Les dermatoses non infectieuses representaient 13 % des dermatoses avec une predominance de l’eczema de contact chez 17 detenus. Cent quatre-vingt-neuf (59 %) patients se douchaient irregulierement, 62 % n’utilisaient pas de savon pour la douche, 51 % changeaient irregulierement les habits apres la douche, 70 % des cellules etaient irregulierement assainies. Soixante-quinze pour cent des patients n’avaient jamais eu de consultation dermatologique. Nous avons trouve un lien statistiquement significatif entre la survenue de dermatoses infectieuses et les conditions d’hygiene en milieu carceral notamment la frequence de la douche, l’utilisation du savon la frequence du changement d’habits. Discussion En Guinee, l’etat de sante des detenus est peu etudie. La prevalence des affections dermatologiques dans cette etude etait de 27,3 %. Ces resultats soulignent la forte morbidite dans cette population en ce qui concerne les pathologies dermatologiques. Conclusion Cette etude releve l’importance des dermatoses en milieu carceral guineen. Malgre la benignite des pathologies rencontrees, l’instauration d’une consultation dermatologique et le renforcement des mesures d’hygiene pourront contribuer a la reduction de cette morbidite.