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Background: The emergence of Plasmodium falciparum resistance to artemisinin and its derivatives, manifested as delayed parasite clearance following the treatment, has developed in Southeast Asia. The spread of resistance to artemisinin from Asia to Africa may be catastrophic for malaria control and elimination worldwide. Recently, mutations in the propeller domain of the Kelch 13 (k13) gene (PF3D71343700) were associated with in vitro resistance to artemisinin and with delayed clearance after artemisinin treatment in southern Asia. The aim of the study was to characterize the genetic variability of k13 and to evaluate the molecular resistance to artemisinin for the first time in Senegal., Methods: Plasmodium falciparum isolates were collected from 138 malaria patients in Dakar and its districts during the rainy season of October 2012 to January 2013 at the Hôpital Principal de Dakar. The k13 gene was amplified using nested PCR and sequenced., Results: A very limited variability within the k13 gene in Senegalese P. falciparum isolates was identified. No polymorphism was detected in the six k13-propeller blades. Only two mutations, T149S (6.3%) and K189T (42.2%), and one (N) or two (NN) asparagine insertion at the codon 142 (4.7 and 6.3%, respectively) were detected in the Plasmodium/Apicomplexa-specific domain. None of the polymorphisms associated with artemisinin resistance in Southeast Asia was detected in the 138 P. falciparum from Dakar., Discussion: The present data do not suggest widespread artemisinin resistance in Dakar in 2012-2013. Notably, the C580Y, R539T or Y493H substitutions that were associated with in vitro resistance or delayed parasite clearance in Southeast Asia were not observed in Dakar, nor were any of the polymorphisms observed in parasites from Southeast Asia, nor the M476I mutation that was selected in vitro with artemisinin pressure in a African parasite line.

The involvement of Pfmdr1 (Plasmodium falciparum multidrug resistance 1) polymorphisms in antimalarial drug resistance is still debated. Here, we evaluate the association between polymorphisms in Pfmdr1 (N86Y, Y184F, S1034C, N1042D, and D1246Y) and Pfcrt (K76T) and in vitro responses to chloroquine (CQ), mefloquine (MQ), lumefantrine (LMF), quinine (QN), monodesethylamodiaquine (MDAQ), and dihydroartemisinin (DHA) in 174 Plasmodium falciparum isolates from Dakar, Senegal. The Pfmdr1 86Y mutation was identified in 14.9% of the samples, and the 184F mutation was identified in 71.8% of the isolates. No 1034C, 1042N, or 1246Y mutations were detected. The Pfmdr1 86Y mutation was significantly associated with increased susceptibility to MDAQ (P = 0.0023), LMF (P = 0.0001), DHA (P = 0.0387), and MQ (P = 0.00002). The N86Y mutation was not associated with CQ (P = 0.214) or QN (P = 0.287) responses. The Pfmdr1 184F mutation was not associated with various susceptibility responses to the 6 antimalarial drugs (P = 0.168 for CQ, 0.778 for MDAQ, 0.324 for LMF, 0.961 for DHA, 0.084 for QN, and 0.298 for MQ). The Pfmdr1 86Y-Y184 haplotype was significantly associated with increased susceptibility to MDAQ (P = 0.0136), LMF (P = 0.0019), and MQ (P = 0.0001). The additional Pfmdr1 86Y mutation increased significantly the in vitro susceptibility to MDAQ (P < 0.0001), LMF (P < 0.0001), MQ (P < 0.0001), and QN (P = 0.0026) in wild-type Pfcrt K76 parasites. The additional Pfmdr1 86Y mutation significantly increased the in vitro susceptibility to CQ (P = 0.0179) in Pfcrt 76T CQ-resistant parasites., (Copyright © 2014, American Society for Microbiology. All Rights Reserved.)

Purpose: To report our experience with Flexible Ureteroscopy-laser (FU-L) in the treatment of renal and/or ureteric stones., Patients and Methods: We conducted a retrospective study of 191 kidney and/or ureteric stones treated in the urology department of New Civil Hospital (Strasbourg) over a period of 2 years. Two hundred and nineteen FU-L were performed. We were interested in the indications of FU-L, its complications, treatment outcomes and predictors of obtaining a stone-free outcome. Postoperative complications were reported according to the Clavien-Dindo classification., Results: The indications were first line in 62.3% of cases, failures of shock wave lithotripsy in 26.2% of cases and failure of alkalinization of urine in 5.2% of cases. As intraoperative complications, we had one case of ureteropelvic avulsion and one case of bronchospasm leading to stop ureteroscopy. Postoperative complications occurred after 38 FU-L (17.3%). All grades combined these postoperative complications were infectious in 50% of cases. They were grade I, II, III, IV and V respectively in 5.9; 7.3; 2.7; 1.3 et 0% of cases. Their occurrence was not significantly correlated to the size of the stones or the unilateral or bilateral nature of the FU-L. The overall rate of stone-free was 71.7%. The factors determining significantly a stone-free outcome were the size of kidney stone and experience of the operator., Conclusion: In our center, the FU-L is increasingly used as first-line option due to its low morbidity and excellent results especially for the treatment of kidney stones less than 20mm and ureteric stones. It is a quality alternative to PCNL in kidney stones over 20mm., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Purpose: To describe the epidemiological, anatomico-clinical and therapeutic aspects of the patent vaginoperitoneal canal (PVPC) in urological practice and to compare our results with those of pediatric teams., Patients and Methods: We performed a retrospective descriptive study of PVPC cases operated in a urology unit. The following parameters were studied: medical history, age, method of installation, the anatomo-clinical type, side and the results of the treatment., Results: A total of 163 cases were collected over a period of 5 years. The average age was 7.5 ± 7 years with a range of 2 months and 39 years. Thirty-four patients had less than or equal to age 2 ears and 28 patients were adults. The reason for consultation was an inguinal or scrotal inguinal, painless and intermittent swelling in 72.3% of cases. Installation mode was progressive in 45 patients (27.6%). The PVPC was sitting right in 81 patients (49.7%) and was bilateral in 12 patients (7.3%). The anatomo-clinical types were dominated by the communicating hydrocele (52%). The treatment was carried out in controlled surgery in all patients and the mean duration of hospitalization was 24 hours. The postoperative course was marked by 5 cases of scrotal hematoma and 2 cases of parietal suppuration. Postoperative mortality was zero. After a mean postoperative decrease of 2 years we observed 3 cases of testicular atrophy and two recurrences., Conclusion: Our results in terms of morbidity and mortality although satisfactory were lower than those of pediatric teams., Level of Evidence: 5., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Introduction: This report documents a rare case of Chryseobacterium indologenes urinary tract infection in Senegal. Chryseobacterium indologenes is an uncommon human pathogen reported in hospital outbreaks in Taiwan and there have been some sporadic cases reported in Europe and in the USA mainly from immune-suppressed patients., Case Presentation: This case report describes a 42-year-old woman of Wolofa ethnicity who was hospitalized in our Department of Internal Medicine in a Senegalese university teaching hospital, with acute leukemia who died of severe sepsis 10 days following her hospitalization. A strain of Chryseobacterium indologenes isolated from her urine sample was resistant to several beta-lactams including ampicillin (minimum inhibitory concentrations ≥ 256 μg/mL), cefotaxime (minimum inhibitory concentrations 32 μg/mL) and imipenem (minimum inhibitory concentrations ≥ 32 μg/mL), whereas it was susceptible to piperacillin (minimum inhibitory concentrations 16 μg/mL), cefepime (minimum inhibitory concentrations 4 μg/mL), ceftazidime (minimum inhibitory concentrations 4 μg/mL), trimethoprim-sulfamethoxazole (minimum inhibitory concentrations ≤ 0.25 μg/mL) and all tested quinolones including nalidixic acid (minimum inhibitory concentrations ≤ 2 μg/mL)., Conclusions: Chryseobacterium indologenes although uncommon, is an important pathogen causing infection in hospitalized patients. The management of this infection needs better identification, drug susceptibility testing and monitoring of immunosuppressed patients with long hospitalizations.

Scrotal calcinosis is a rare pathology and etiology still discussed. We report five cases in patients without particular history of another disease. Clinical examination revealed scrotal wall with painless nodules of various sizes producing a whitish substance, pasty. The phosphate levels were normal in all patients. They all had a resection of the lesions associated with scholarships plasty recovery. Histopathological study revealed calcified epidermoid cysts in 4 cases., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Bilharzioma are inflammatory pseudotumors, which often pose the problem of differential diagnosis with neoplastic processes. Using the keywords "testicular" and "schistosomiasis", there are only 14 cases of testicular bilharzioma identified on PubMed. The authors report two new cases in a 6-year-old child and an adult of 38 years, collected over a period of 5 years. In both cases, orchidectomy was performed and histological analysis of the surgical specimen was allowed to diagnose testicular bilharzioma by Schistosomia haematobium. The authors emphasize the need to evoke a bilharzioma before any testicular nodule in a patient living in an endemic area., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Objective: Describe the epidemiology, diagnosis and treatment of vesicovaginal fistula (VVF)., Patients and Methods: We conducted a retrospective descriptive study of all cases of VVF secondary to hysterectomy. The following parameters were studied: age, parity, indication for hysterectomy, risk factors, the consultation period, the anatomical type of VVF, the paraclinical, the surgical approach and results of the cure., Results: Fourteen cases were identified over 10 years. All hysterectomies were performed by laparotomia. The average age of patients was 54.3±13 years. Hysterectomy was performed in view of a uterine leiomyoma in eight cases, a cancer of the cervix in four cases, a menometrorrhagia in one case and a choriocarcinoma in one case. Four patients had received neoadjuvant radiotherapy. The mean time from injury was 13.5±18 months. Examination under valve was allowed to find 11 VVF type 1 and three type 2 VVF. IVU was normal in seven patients and allowed to find an ureterohydronephrose stage III in one patient. VVF was addressed by high in ten cases including 5 by transperitoneovaginale and 5 by transvesical pure. The postoperative course was uneventful in 11 patients (78%) but marked by vesicocutaneous fistula, parietal suppuration and one failure., Conclusion: In this short series of post-hysterectomy VVF treated by laparotomia, we observed a rate of cure satisfying in spite of an important psychosocial morbidity., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Background: Although the World Health Organization recommends replacing quinine (QN) by artesunate due to its increased efficacy and the higher tolerance to the drug in both adults and children, QN remains a first-line treatment for severe malaria, especially in Africa. Investigations of microsatellite Pfnhe-1 ms4760 polymorphisms in culture-adapted isolates from around the world have revealed that an increase in the number of DNNND amino acid motifs was associated with decreased QN susceptibility, whereas an increase in the number of DDNHNDNHNND motifs was associated with increased QN susceptibility., Methods: In this context, to further analyse associations between Pfnhe-1 ms4760 polymorphisms and QN susceptibility, 393 isolates freshly collected between October 2009 and January 2010 and July 2010 and February 2011, respectively, at the Hôpital Principal de Dakar, Senegal were assessed ex vivo for QN susceptibility, and their genes were amplified and sequenced., Results: Of the 393 Plasmodium falciparum clinical isolates collected, 145 were successfully cultured. The 145 QN IC50s ranged from 2.1 to 1291 nM, and 17 isolates (11.7%) exceed the QN reduced susceptibility threshold of 611 nM. Among the 393 P. falciparum clinical isolates, 47 different alleles were observed. The three most prevalent profiles were ms4760-1 (no = 72; 18.3%), ms4760-3 (no = 65; 16.5%) and ms4760-7 (no = 40; 10.2%). There were no significant associations observed between QN IC50 values and i) the number of repeats of DNNND in block II (p = 0.0955, Kruskal-Wallis test); ii) the number of repeats of DDNHNDNHNND in block V (p = 0.1455, Kruskal-Wallis test); or iii) ms4760 profiles (p = 0.1809, Kruskal-Wallis test)., Conclusions: Pfnhe-1 ms4760 was highly diverse in parasite isolates from Dakar (47 different profiles). Three profiles (ms4760-1, ms4760-3 and ms4760-7) were predominant. The number of repeats for block II (DNNND) or block V (DDNHNDNHNND) was not significantly associated with QN susceptibility. New studies, and especially in vivo studies, are necessary to confirm the role of Pfnhe-1 ms4760 as a marker of QN resistance.

Background: In 2006, the Senegalese National Malaria Control Programme recommended artemisinin-based combination therapy (ACT) as the first-line treatment for uncomplicated malaria. Since the introduction of ACT, there have been very few reports on the level of resistance of P. falciparum to anti-malarial drugs. To determine whether parasite susceptibility has been affected by the new anti-malarial policies, an ex vivo susceptibility and drug resistance molecular marker study was conducted on local isolates obtained from the Centre de santé Elizabeth Diouf (Médina, Dakar, Senegal)., Methods: The prevalence of genetic polymorphisms in genes associated with anti-malarial drug resistance, i.e., pfcrt, pfdhfr, pfdhps and pfmdr1, were evaluated for a panel of 165 isolates collected from patients recruited from 17 August 2010 to 6 January 2011. The malaria isolates were assessed for susceptibility to chloroquine (CQ); quinine (QN); monodesethylamodiaquine (MDAQ), the active metabolite of amodiaquine; mefloquine (MQ); lumefantrine (LMF); dihydroartemisinin (DHA), the active metabolite of artemisinin derivatives; and doxycycline (DOX) using the Plasmodium lactate dehydrogenase (pLDH) ELISA., Results: The prevalence of the in vitro resistant isolates, or isolates with reduced susceptibility, was 62.1% for MQ, 24.2% for CQ, 10.3% for DOX, 11.8% MDAQ, 9.7% for QN, 2.9% for LMF and 0% for DHA. The Pfcrt 76T mutation was identified in 43.6% of the samples. The pfmdr1 86Y, 184F and 1246Y mutations were found in 16.2%, 50.0% and 1.6% of the samples, respectively. The pfdhfr 108N, 51I and 59R mutations were identified in 81.9%, 77.4% and 79.4% of the samples, respectively. The double mutant (108N and 51I) was detected in 75.5% of the isolates, and the triple mutant (108N, 51I and 59R) was detected in 73.6% of the isolates. The pfdhps 437G, 436A and 613S mutations were found in 54.4%, 38.6% and 1.2% of the samples, respectively. There was only one double mutant, 437G and 540E, and one quintuple mutant, pfdhfr 108N, 51I and 59R and pfdhps 437G and 540E. The prevalence of the quadruple mutant (pfdhfr 108N, 51I and 59R and pfdhps 437G) was 36.7%., Conclusions: The results of this study indicate that an intensive surveillance of the in vitro P. falciparum susceptibility to anti-malarial drugs must be conducted in Senegal.

Objectives: To evaluate the results of Anderson-Hynes open pyeloplasty in our institution. And then to compare them to those of laparoscopic procedure and identify what can be considered now as the indications of the open procedure., Patients and Methods: It was a retrospective study on 30 cases of ureteropelvic junction syndrome managed by Anderson-Hynes open procedure. The clinical, biological and radiologic characteristics of the patients as well as the surgical technique and its results were taken into account. The patients were classified, according to Valdeyer and Cendron classification as type II in eight cases (26.7%), type III in ten cases (33.3%) and type IV in four cases (13.3%). There were also eight cases of giant hydronephrosis (26.7%). The operating time, the length of hospital stay and the outcomes were studied and compared with those of the laparoscopic pyeloplasty found in the medical literature., Results: The mean operating time was 115 ± 33.4 minutes (90-230 min). The mean length of hospital stay was 10.4 ± 5.1 days. Six patients (20%) had postoperative complications. After a mean follow-up of 28 ± 13.7 months (13-48 months), our first-hand success rate was 90% (n=27)., Conclusion: Anderson-Hynes open pyeloplasty reached good results but nowadays its indications can be limited to laparoscopic contraindications, severe hydronephrosis (grade IV or giant hydronephrosis) and second-hand cases. The two latter indications depend on the surgeon experience in laparoscopic surgery., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

We report the case of Conn's adenoma in a 36-year-old woman, revealed by low extremities weakness. The patient had hypertension at 170/90 mmHg. Her initial potassium level was low i.e., 1.5 mmol/L. The diagnosis, confirmed by hormonal investigation, showed an elevation of plasma aldosterone and lower plasma renin activity. Abdominal MRI revealed a lesion in left adrenal gland, measuring 1.8 cm in diameter and taking contrast in periphery, compatible with an adrenal adenoma. The patient underwent a left laparoscopic adrenalectomy and microscopic examination confirmed the diagnosis. The postoperative course was uneventful with normalization of serum potassium level and blood pressure., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

The purpose of this report is to describe four cases of nocardiosis observed over an eight-year period in medical units of Principal Hospital in Dakar, Senegal. It is a rare infection occurring mainly in people with weakened immune systems. Pulmonary forms are predominate and clinical and laboratory presentation can mimic pulmonary tuberculosis. Diagnosis should be suspected in patients presenting pulmonary infections and negative sputum bacilloscopy. Nocardia bacteria should be identified before starting antibiotic treatment. Patients require long-term antibiotic treatment with third generation cephalosporins or sulfamethoxazole-trimethoprim.

Objective: To identify the etiology and current clinical characteristics of male urethral stricture disease (USD) in Senegal., Patients and Methods: A retrospective and mono-centric study over a 10-year period (between January 1999 and December 2008) was carried out and included all male patients with USD admitted to the Urology Department of Aristide Le-Dantec Hospital (Dakar)., Results: We recorded 414 USD cases. The maximum annual incidence was observed in 2004, and from then, the incidence tended to decrease gradually. The mean age of patients was 43.7 ± 19.6 years (1-89 years), and 43% of patients were younger than 40 years old. The mean time from symptoms onset to the consultation was 20.1 ± 24.9 months (1-120 months). Most patients (42.2%) were admitted because they suffered dysuria. In 57.8% of patients, USD was diagnosed with complications. The most common site of stricture was at the bulbar urethra (72.7%). The length of the urethral stricture was smaller than 1 cm in 59.6% of patients, between 1 and 3 cm in 28.5% and between 3 and 5 cm in 7.7%. The stricture was longer than 5 cm in eight patients and was staged (multifocal) in nine patients. The etiology of urethral stricture was infectious in 63% of patients, traumatic in 13.7% and iatrogenic in 8.2%. The etiology was not identified in 14.9% of cases. The infectious etiology was urethritis in 259 cases and urogenital schistosomiasis in 12 cases. A study of the etiology according to stricture site showed that bulbar USD was infectious in 77.7% of cases and that all membranous USD cases were traumatic., Conclusion: Male urethral stricture in Senegal is often a sequela of gonococcal urethritis and is frequently detected because of infectious complications such as gangrene of the genitalia or urinary tract infections. Its prevention in this geographical region thus requires fighting against sexually transmitted infections and treating appropriately and effectively all urethritis.

Background: As a result of widespread chloroquine and sulphadoxine-pyrimethamine resistance, artemisinin-based combination therapy (ACT) (which includes artemether-lumefantrine and artesunate-amodiaquine) has been recommended as a first-line anti-malarial regimen in Senegal since 2006. Since then, there have been very few reports on the ex vivo susceptibility of Plasmodium falciparum to anti-malarial drugs. To examine whether parasite susceptibility has been affected by the widespread use of ACT, the ex vivo susceptibility of local isolates was assessed at the military hospital of Dakar., Methods: The ex vivo susceptibility of 93 P. falciparum isolates from Dakar was successfully determined using the Plasmodium lactate dehydrogenase (pLDH) ELISA for the following drugs: chloroquine (CQ), quinine (QN), mefloquine (MQ), monodesethylamodiaquine (MDAQ), lumefantrine (LMF), dihydroartemisinin (DHA) and doxycycline (DOX)., Results: After transformation of the isolate IC50 in ratio of IC50 according to the susceptibility of the 3D7 reference strain (isolate IC50/3D7 IC50), the prevalence of the in vitro resistant isolates with reduced susceptibility was 50% for MQ, 22% for CQ, 12% for DOX, 6% for both QN and MDAQ and 1% for the drugs LMF and DHA. The highest significant positive correlations were shown between responses to CQ and MDAQ (r = 0.569; P < 0.0001), LMF and QN (r = 0.511; P < 0.0001), LMF and DHA (r = 0.428; P = 0.0001), LMF and MQ (r = 0.413; P = 0.0002), QN and DHA (r = 0.402; P = 0.0003) and QN and MQ (r = 0.421; P = 0.0001)., Conclusions: The introduction of ACT in 2002 has not induced a decrease in P. falciparum susceptibility to the drugs DHA, MDAQ and LMF, which are common ACT components. However, the prevalence of P. falciparum isolates with reduced susceptibility has increased for both MQ and DOX. Taken together, these data suggest that intensive surveillance of the P. falciparum in vitro susceptibility to anti-malarial drugs in Senegal is required.

Purpose: To report epidemiological, clinical and paraclinical features of pyonephrosis and describe current management methods in Senegal., Patients and Methods: This retrospective study includes a series of patients admitted for pyonephrosis to the Urology Department of the Aristide Le Dantec Hospital in Dakar between 1995 and 2009. The following information was collected for each patient: age, sex, clinical manifestations, diagnostic findings, treatment modalities and outcomes., Results: A total of 44 patients with a mean age of 34 years were included. The most common clinical manifestations were acute flank pain, sepsis and renal mass. Diagnostic was usually based on medical imaging, i.e., renal utrasonography and computed tomography. Urolithiasis was the underlying etiology in 73.2% of cases. Nephrectomy was performed in 83% of cases with or without preliminary nephrostomy catheterization., Conclusion: Development of both diagnostic (medical imaging) and therapeutic methods for management of pyonephrosis has been consistent with the rarity of this condtion in Senegal.

Objective: To study current epidemiological and clinical features of adult renal cancer in Senegal and the evolution of these features over the two past decades., Patients and Methods: We conducted a retrospective ten years study (2000-2009) that analyzed all the renal cell cancer in adult admitted in the urology department and the pathology department of the university teaching hospital Aristide-Le-Dantec (Dakar). The results of this study were compared with those of the previous decade., Results: We included 74 cases of renal cell cancer. The median age of patients was 49 years (18-72 years). There was a slight female predominance (51.3%). Twenty-eight (37.8%) patients presented at least with one renal cell cancer risk factor. The median duration of symptoms was 10 months (1-96 months). The localization of the renal cancer was right in 42 patients (56.7%) and left in 32 cases (43.8%). Almost all the tumors were symptomatic. Symptoms were dominated by loin pain (87.8%) and abdominal mass (77%). There were only two cases (2.7%) of incidental renal cell cancer. The median tumor size was 12 cm (2.4-26 cm). The more frequent tumor stages according to the TNM 2002 staging system were T2 (39.2%) and T3 (33.7%). Metastases were found in 23 (31%) patients. Forty-four patients underwent nephrectomy (43 radical and one partial). No adjuvant treatment or metastasectomy were done. The main histological subtype of tumors was renal cell carcinoma (47 cases). The mean duration of the follow up was 30.5 ± 33.6 months. Among the 44 patients who underwent nephrectomy, no tumor recurrence was found on 35 cases. Tumor recurrence occurred on nine patients. The specific mortality rate was 47.3%. Epidemiological and clinical features of the adult renal cell cancer in Senegal haven't significantly changed over the 20 past years., Conclusion: The adult renal cell cancer incidence was low in Senegal. Its clinical profile was characterized by a predominance of locally advanced and metastatic forms., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Renal cell carcinoma (RCC) in children is rare. This entity has different clinical and biological presentation characteristics from adult RCC. In contrast to Wilms tumor, the efficacy of chemotherapy and radiation therapy in pediatric RCC remains uncertain. Debate continues on the importance of lymph node dissection. The authors present a case of RCC with lymph node involvement in a 12-year-old boy. The treatment was radical nephrectomy and a limited lymphadenectomy. No adjuvant therapy was given. After 13 months of follow-up, there is no evidence of recurrence. This case shows that lymph node involvement (in the absence of distant metastases) is not associated with a poor prognosis in pediatric RCC and that lymphadenectomy in lymph node-positive cases is important., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Unlabelled: To describe clinical and therapeutic features of ischemic priapism associated with sickle cell disease (SSD) in Senegalese men and to identify risk factors for erectile dysfunction (ED)., Patients and Methods: The charts of all patients admitted to the Urology Department of Aristide Le Dantec University Teaching Hospital (Dakar) for ischemic priapism associated with SSD between January 2000 and September 2008 were retrospectively reviewed., Results: A total of 22 patients with a mean age of 19.5 +/- 9.9 years (6 - 41 years) were identified. The most affected age group was between 21 and 30 years. The mean duration between onset of the episode and admission was 89.6 +/- 103.1 hours (4 - 384 hours). Nine patients (40.9%) were admitted within 24 hours after the onset. Eight patients (36.3%) had a history of stuttering priapism. The sickle cell phenotype identified by electrophoresis was SS in 18 patients and AS in four. The main treatment modalities were corporeal aspiration that was performed with or without intracavernosal injection of sympathomimetics drugs and Al Ghorab shunt surgery that was used in ten patients with a success rate of 90 % (complete detumescence). With a mean follow-up of 3.8 +/- 1.5 years, nine (69.2%) of the 13 patients older than 16 years developed ED. The incidence of ED was significantly correlated with the duration of the priapism but not with SSD phenotype., Conclusion: In Senegal ischemic priapism associated with sickle cell disease occurs mainly in young people. The incidence of ischemic priapism appears to be low but ED is common due to the prolonged duration of priapism.

Introduction: The bacteriological characteristics of Helicobacter pylori (HP) vary in function of time and place. The aim of this study was to update histological and bacteriological feature of HP infection in patients presenting gastroduodenal lesions in Dakar, Senegal., Patients and Method: This prospective study included patients with gastroduodenal lesions managed over a 6-month period in a digestive endoscopy center in Dakar. In all cases gastric biopsy was performed to obtain specimens for histological diagnosis according Sydney modified classification and HP culture with antibiogram., Results: A total of 158 patients were included. Mean patient age was 48.7 years and the sex-ratio was 1.2. Endoscopic lesions were ulcer in 88 cases, gastritis in 54 cases and tumors in 16. Histological examination demonstrated chronic gastritis in 100% of cases, inflammatory activity in 79.1%, metaplasia in 78.5%, gastric atrophy in 41.1%, adenocarcinoma in 7.6%, dysplasia in 5.7%, and MALT lymphoma in 2.5% with presence of HP in 72.8% of cases. Cultures were positive for HP in 65.8% of cases. Antibiograms indicated that HP was sensitive to amoxicilline in 100% of cases, clarithromycine in 96.6%, ciprofloxacine in 84.1%, and métronidazole in 29.5%., Conclusion: Chronic gastritis is a constant feature of gastroduodenal lesions in Dakar. Histology combined with culture showed HP infection in 78.5% of cases. The antibiotic sensitivity of HP in Dakar has changed over the past decade.

Purpose: To report the oncologic results and morbidity of bilateral pulpectomy and to identify factors that make this method of androgen suppression therapy the most used in our country., Patients and Methods: We conducted a prospective study in the urology department of Aristide Le-Dantec hospital (Dakar) between January 2008 and June 2010 (30 months). It included 84 cases of prostate cancer treated by bilateral pulpectomy under local anesthesia., Results: The mean age of patients was 72.17±12.48 years (53-91). The median PSA level was 101 ng/mL (12.18-9990). Metastasis have been detected in 75% of cases. The Gleason score was higher than 7 in 40 patients (47.6%). Three months after pulpectomy, an improvement of performance status was seen in 76 patients (90.4%). The back pain significantly decreased in intensity or disappeared in 65.3% (32/49) of cases. A complete recovery of lower limbs motor deficit was observed in 50% of cases (7/14). The PSA levels decreased in 57 of the 76 patients alive and the mean PSA level was then 72±11.7 ng/mL (3.8-2433). At six months, of the 53 patients in urinary retention, 18 had recovered spontaneous and complete urination. The PSA level was below 4 ng/mL in 33.8% (22/65) of cases and between 4 and 10 ng/mL in 52.3% (34/65) of cases. At 12 months, the median PSA nadir was 0.76 ng/mL (0,002-8,17) and 57.4% of the 54 patients alive had a PSA nadir less than 2 ng/mL. The mean follow-up was 11.08±10.34 months (1-30). A rising PSA occurred in 17 patients (20.2%) after an mean progression-free survival of 10.5 months (6-25). The overall survival at 6, 12 and 24 months were respectively 77.3, 64.3 and 52.3%. The overall cost of pulpectomy was 50 000 FCFA (76€). The specific morbidity of pulpectomy was two cases (2.4%) of infection of the operative site., Conclusion: The bilateral pulpectomy was a method of androgen suppression immediately effective, efficacious with a low morbidity. Its very low cost is the main reason why it is still the most used method in our country., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Purpose: To report the cases of urolithiasis in children and to assess epidemiological, clinical and therapeutically aspects., Patients and Methods: We study retrospectively the cases of urolithiasis in children of 0 to 15 years old between 2003 and 2008. The parameters of study were: age, sex, clinical and therapeutically aspects., Results: We report 20 cases. The mean age was 5.4 years. The sex-ratio was 9/1. Dysuria was the most common symptom. Abdominal plain radiography associate with ultrasonography permitted the diagnostic in most cases. Stone location was in the bladder mainly (n = 12). Posterior Urethra valves were the common etiology found. The surgical treatment was performed in all cases and consisted of cystolithotomy in the majority., Conclusion: Children urinary stones are less common than in adults. The etiologies are different but the treatment is coming to be alike.

Objective: To assess the feasibility of selective clamping of segmental renal arteries during partial nephrectomy, in order to limit renal infarction to the pathological area to be resected., Materials and Methods: A dissection of renal artery and its extraparenchymal branches was realised. The study included 30 kidneys from recent nonformolised corpses. The size, distribution, and accessibility of the arteries were considered. All the corpses underwent a lombotomy with or without rib resection., Results: The majority of dissected kidneys had a unique artery (96.66% of cases). The number of segmental arteries was zero in five cases (16.66%), one in four cases (13.33%), two in four cases (13.33%), three in one case (3%), four in 15 cases (50%) and five in five cases (16.66%). The posterior and inferior segmental arteries were more accessible to isolate with a respective ratio of 94 and 100% at segmental level. Apical and middle segmental arteries were least accessible with a respective ratio of 73 and 80%. The majority of accidents during dissection occurred with the middle segmental artery (62.5% of vascular lesions)., Conclusion: This anatomic dissection on corpses showed that selective renal segmental arteries is possible in the majority of cases. This dissection is better indicated in partial nephrectomies for renal tumours located posteriorly or in the lower pole.

Objective: To present the epidemiological, clinical and therapeutic features of the urological emergencies in Senegal, West Africa., Material and Methods: The authors conducted a 20 months retrospective study that analyzed the epidemiological, clinical and therapeutic features of all urological emergencies admitted to the urology department of the university teaching hospital Aristide-Le-Dantec (Dakar)., Results: There were 1237 urological emergencies. The mean age of the patients was 58.8 years (range one month-94 years). The sex ratio (M/F) was 20.32. These patients had an age equal to or higher than 60 years in 50.7% of the cases. The most frequent illness was urinary retention (53%) and genitor-urinary system infectious, which represented as a whole 16.4% of the cases. The gangrenes of male external genitalia (Fournier's gangrene) accounted for 4.1% of the cases and the priapism 1.3%. In emergency, 331 surgical operations were performed. The most performed procedures were the installation of a suprapubic catheter (59.8%) and debridement of a gangrene of male external genitalia (15.4%)., Conclusion: The most frequent urological emergency in our country was the acute urinary retention. Some serious illness like gangrene of male external genitalia (Fournier's gangrene) and priapism are not rare there.

Objective: Sickle cell disease is a public health problem in Africa. The aim of this prospective study was to evaluate per and post-operative complications of laparoscopic cholecystectomy in sickle cell children in Senegal., Methods: from January 1999 to December 2006, an anesthetic protocol was applied to 39 sickle cell children undergoing a cholecystectomy. Among them, 20 experienced laparoscopic cholecystectomy., Results: All these 20 patients had previously suffered from sickle cell visceral complications and were classified as ASA II (11 cases) and as ASA III (9 cases). Blood transfusion program aimed at sustaining haemoglobin level between 10 and 12 g/dl was implemented. The preoperative monitoring and anesthesia management were the same for these patients. During perioperative period, the prevention of pain, hypovolemia, hypothermia and acidosis was achieved. The mean insufflation duration of laparoscopy was 23 min (17-60 min), the mean surgery duration was 55 min (40-110 min), and the mean anesthesia duration was 78 min (88-135 min). Postoperative complications occurred in 9 patients: acute chest syndrome (n=2), postoperative hemolysis (n=5), vaso-occlusive crisis (n=2)., Conclusion: Laparoscopic cholecystectomy can be carried out in sickle cell children affected with gallstones, provided that general anaesthetic rules were respected. An appropriate pre-, per- and postoperative anaesthesia is mandatory to reduce postoperative complications in children with sickle cell disease. Searching for early diagnosis of gallstones before occurrence of visceral complications should allow further optimal laparoscopic surgery.

Duchenne muscular dystrophy (DMD) is characterized in skeletal muscle by cycles of myofiber necrosis and regeneration leading to loss of muscle fibers and replacement with fibrotic connective and adipose tissue. The ongoing activation and recruitment of muscle satellite cells for myofiber regeneration results in loss of regenerative capacity in part due to proliferative senescence. We explored a method whereby new myoblasts could be generated in dystrophic muscles by transplantation of primary fibroblasts engineered to express a micro-dystrophin/enhanced green fluorescent protein (muDys/eGFP) fusion gene together with a tamoxifen-inducible form of the myogenic regulator MyoD [MyoD-ER(T)]. Fibroblasts isolated from mdx(4cv) mice, a mouse model for DMD, were efficiently transduced with lentiviral vectors expressing muDys/eGFP and MyoD-ER(T) and underwent myogenic conversion when exposed to tamoxifen. These cells could also be induced to differentiate into muDys/eGFP-expressing myocytes and myotubes. Transplantation of transduced mdx(4cv) fibroblasts into mdx(4cv) muscles enabled tamoxifen-dependent regeneration of myofibers that express muDys. This lineage control method therefore allows replenishment of myogenic stem cells using autologous fibroblasts carrying an exogenous dystrophin gene. This strategy carries several potential advantages over conventional myoblast transplantation methods including: (i) the relative simplicity of culturing fibroblasts compared with myoblasts, (ii) a readily available cell source and ease of expansion and (iii) the ability to induce MyoD gene expression in vivo via administration of a medication. Our study provides a proof of concept for a novel gene/stem cell therapy technique and opens another potential therapeutic approach for degenerative muscle disorders.

Objective: To present the epidemiological, clinical and histological profile of the bladder cancer in Senegal., Material and Method: The authors conducted a retrospective study based on registries and clinical data of patients admitted for bladder cancer confirmed by the histology at the university hospital Aristide-Le-Dantec of Dakar., Results: Four hundred and twenty-eight bladder cancers were recorded. The incidence of the bladder cancer was 2.5% of the whole of cancers. The mean age of the patients was 45.5 years (range 12-86 years). The sex-ratio was 1.25. The majority of the patients consulted for low urinary tract symptoms (94.5%) and hematuria (88%). The prevalent histological type was squamous cell carcinoma (50.70%)., Conclusion: The bladder cancer in Senegal is a cancer of the young adult. The prevalent histological type is squamous cell carcinoma.

Unlabelled: Prune Belly syndrome (PBS) is a rare complex malformation with male predominance. His pathogeny is not yet completely elucidated. The goal of this work is to analyze the epidemiological, anatomoclinical and treatment aspects of a retrospective trial in Aristide-Le-Dantec Hospital., Patients and Methods: We carried out a retrospective study about 22 cases collected in the departments of urology-andrology and pediatric surgery in Aristide-Le-Dantec Hospital between April 1995 and November 2004., Results: The mean age of the patients was 15 months with extremes of one day and 10 years. The somatic examination revealed 20 cases of complete abdominal muscle aplasia, one right partial form and the last case had a left partial form. Nineteen patients were managed with conservative treatment and three patients benefited a surgical act for urinary abnormalities. The Montfort intervention was performed in two patients respectively aged eight and 10 years. The orchidopexy, stage 1, by Fowler-Stephens technique was performed in 13 cases. Five cases of death and nine cases of testicular atrophy after orchidopexy occurred. The followings were satisfactory in the three operated patients for urinary abnormalities., Conclusion: The renal failure is the main cause of death. The management of the urinary tract abnormalities must be performed individually. The testis descending should be performed in newborn period to enhance the fertility chances. The abdominoplasty also should be done early for aesthetic reason and to improve pulmonary, defecation, and voiding functions.

Introduction: The goal of this study is to access the surgical management of the prostate cancer., Patients and Methods: It was a retrospective study including 96 cases of prostate cancer between June 2002 and December 2004. Parameters studied for every patient was: age, the complaints, results of rectal digital examination, the initial TPSA rate, gleason score, results of extension, the clinical grade according to TNM 2002 classification, the treatment and the future of treated patients., Results: The mean age of our patients was 70.9 years with extremes of 50 years and 93 years. The complaints at presentation were dominated by prostatism (43.5%) and urine retention (37.7%). At rectal digital examination, the prostate was suspicious of cancer in 42.7%. The majority of our patients (79.8%) had a TPSA rate superior to 20 ng/ml. The examination revealed that the tumour was an adenocarcinoma in all patients. The majority of our patients (50.3%) had a gleason score inferior to 7. The extension outcome revealed: a loco-regional extension in 63 patients, dorso-lombar bone metastases in 19 patients and absence of secondary localisation in 14 patients. The repartition of patients according TNM classification was as following: T1 (1%), T2 (14.6%), T3 (18.8%) and T4 (65.6%). The patients were managed as following: bladder neck resection (surgically or endoscopically), pulpectomy and radical prostatectomy., Conclusion: To ameliorate the prostate cancer management, the highlights of radical prostatectomy is imperative as the spreading of endoscopic surgery in the place of opening surgery.

The authors report three (3) cases of choledoco-duodenal fistula due to perforating duodenal ulcer disease. All of them were male, aged from 35 to 55 years. The ulcer symptomatology summarised the clinical feature. They presented respectively a prestenosis, a stenosis and a chronic ulcer The fistula diagnosis was estasblished at the oesogastro-duodenal radiologic exploration showing an opacification of the common bile duct. The surgical treatment concerned bnly to the ulcer. A gastrectomy of exclusion with digestive continuity re-establishment according to FINSTERER in the pre-stenosis, vagotomy associated to gastrojejunostomy and the pylore closing at both other were performed. After 24, 23 and 5 months follow-up all the patients were disease free; classified VISICK I. Rarely reported among the complications of the duodenal ulcer the choledoco-duodenal fistula is a reality. Currently the majority of the authors recommend the respect of the fistula in the event of surgical operation.

Aim: To dress biologic and histopathologic aspects of the prostatic cancer in urologic hospital center about a set of digital transrectal guided biopsies., Methodology: It is a prospective study realized between January 2002 and March 2002 (26 months) studying patients with positive prostatic biopsy., Results: Seventy two cases of prostatic cancer were noticed. Mean age of these patients was 69,9 years (54-91 years). Mean rate Total PSA was 134,8 ng/ml (6-2500 ng/ml). Repartition according Gleason score has revealed that only 35% of tumors were well differentiated. The study of correlation between Total PSA rate and Gleason grade has revealed that up to 10 ng/ml Total PSA rate, only 33% of patients had a Gleason grade between 2 and 4 (well differentiated tumor)., Conclusion: Actual biologic and histopathologic profile of prostatic cancer lays emphasis on later management.

Objectives: The aim of this study was to report the transrectal prostate biopsy complications, to identify the factors involved in their occurring and to insist on their prevention., Patients and Methodology: It is a prospective study interested on patients managed in the urological and andrological service in Aristide le Dantec Hospital in Dakar for prostate tumour from February 2002 to March 2004 and in whom the indication of prostate biopsy was performed. All the patients fulfilling the including criteria were taken in care according to a same protocol that was a transrectal sextant biopsy This act was performed under preventive antibiotherapy based on fluoroquinolones started one day before and going on three days after biopsy associated to a rectal preparation performed the same day of biopsy At the end of the biopsy the patient was managed externally during three days after biopsy Following parameters were studied: age of patients, the histopathological results and the post operative complications., Results: Two hundred and four (204) biopsies were performed. The median age of the patients was 69.1 years with the extremes of 42 years and 93 years. The global rate of complications was 13.5% with a majority of bleeding. There no major complication registered. Rectal and urethral bleeding was over in 24 hours. The complete urine retention was under the form of a unique happening complication. The distribution of complications according to the results of the biopsy did not reveal any particularity., Conclusion: The rectal preparation associated to preventive antibiotherapy seems to reduce infectious complications.

Abdominoscrotal hydrocele is a very rare clinical entity especially in childhood with less than 100 paediatric cases reported in the literature. It is associated with various complications and its pathogenesis is still a matter for debate. The authors report a case of abdominoscrotal hydrocele in the child. The methods of the diagnosis as well as the specific treatment are pointed out.

Management of exocrine pancreatic tumors is very difficult: Their impact is in upsurge and their diagnosis is very often made to an advanced stage that only allows the therapeutic palliative. To value the management of these tumors to the surgical clinic of Aristide Le Dantec hospital, authors achieved a retrospective survey on 8years (October 1994 to October 2002). Hundred twenty nine (129) cases of exocrine pancreatic tumors had been counted. It was about 71 men and 58 women of middle age of 56, 96 years. The length of middle evolution of the illness was of 8 months. The most frequent sign was jaundice, recovered at 80.9% of patients. Followed the thinning (79%), the pain (69%), the digestive stenosis (35%). Ultrasonography, scanner and x-ray of lungs permitted to make the diagnosis and the balance of extension. A laparoscopy had been made at 13 patients. A clinic and radiological classification had been used to distribute the tumors in 3 stages. At 46 patients in III stage, a therapeutic abstention had been decided. Patients to the II stage (n=77) had benefitted a palliative surgical treatment. It was about 74 biliary and digestive shunt and 3 alcoholic splanchnicectomy. The 6 patient to the I stage had benefitted a surgical resection. The middle hospitalization length was of 10.75 days. The rate of morbidity was 45.78%. Mortality was 29%. The median survival was of 3.6 months. The palliative surgical treatment had again indications facing these obstructive and locally advanced tumors. But the salute will come from the precocious diagnosis of these tumors to hope for a curative gesture.

The gastroomental (gastroepiploic) arterial circle of the stomach is the main vascular axis of the gastroplasty use as esophagus substitute after esophagectomy. The aim of this anatomoangiographic study is to study the anastomosis between the right and left gastroomental arteries and emphasize interest of the transillumination: an ordinary anatomic method use in surgical practice. We use forty five fresh cadaveric stomach of adult for determine the anastomotic fashion of the arterial circle of the great gastric curvature. About three models of gastric esophagoplasty we verify similarity of vascular transillumination results and we compare with the radiographic exploration. The thickness of the gastrocolic ligament in which progress the gastroomental arterial circle can lead astray for macroscopic determination of anastomotic mode. Thus the type I, II, III and IV which are of 60%, 22,2%, 13,3% and 4,4% at macroscopic observation become 64,1%, 15,4%, 15,4% and 5,1% after arteriographic analysis. Even if the submucosal arteriolar network and the rich parietal anastomosis confer at the stomach the best qualities for esophageal replacement, the multifactorial particularity of success in esophagogastroplasty require identification and preservation of the gastroomental arterial circle. The transillumination which facilitate evaluation of this arterial axis is a simple and accessible process which we advocate.

The esogastric anastomotic fistula,occurring after the replacement of esophagus by the stomach, is a post-operative complication always feared and awaited. Apart from other causes, there exist the anatomical dispositions notably the vascular and technical factors that stress this potential risk despite certain advantages of esophagogastroplasty. The goal of our study was to study the arterial distribution of the gastric transplants in order to identify the better modalities of their making. We used 39 stomachs taken from fresh cadavers of autochtone subjects. After a modeling treatment using three different techniques, they were subjected to a radiographic opacification of the right gastro-epiploic artery with sulphate of barium follow by an x-rays in incidence full-face (25 kv, 10 mAS). It was a matter of 15 entire stomachs (E.E.) with denudation of the small curvature, of 12 wide gastric tubes (W.T.) prepared according to the Akiyama technique modified and of 12 narrow tubes (N.T.) tubulized according to the Marmuse method. We studied the anastomotic type of the gastro-epiploic arterial circle according to the classification of Koskas, the collateral branches of the arterial circles of the gastric curvatures, the antral and corporeal anastomosis of these circles and the distribution anastomotic at the level of the summit of the anastomotic. Only 28 pieces (15 E.E., 8 W.T. and 5 N.T.) were able to be the object of a complete angiographic exploitation. The anastomosis of the arterial circle was type I in 64.1% of the cases, type II in 15.4% of the cases, type III in 15.4% of the cases and type IV in 5.1% of the cases. The average number of collateral branches originating from gastro-epiploic arterial circle was respectively 24, 17 and 22 for the E.E., the W.T. and the N.T. Only the two first ones presented collateral branches being borne of the small curvature circle. Fifty per cent of the N.T. did not possess any antral or corporeal anastomosis between the two arterial circles; some of them were even for a quarter of the W.T. In the case of gastric tubulization there existed an irrigation defect of the summit of the plasty for a third of the N.T. and a quarter of the W.T., despite a constant intramural bridge anastomosis between the two gastro-epiploic arteries. The usage of the entire stomach must be recommended for gastric oesophagoplasty; but when the operative indications require a resection of the small curvature it is preferable to use a wide gastric tube whose diameter respects the two left third of the initial width of the organ.

Aim: To insist on clinical and therapeutical aspects of chronic prostatitis., Patients and Methods: The authors relate a prospective study about 30 patients who were followed for chronic prostatitis. All patients were treated and followed up to 6 months., Results: The mean age of the patients was 31,82 years. Sixty percent of them where send by a physician after failure of medical treatment. Mean delay before consultation were 31.5 months. The main symptoms were pain (pelvic pain, perineal pain, or post ejaculatory pain). The distribution of patients according to the US NIH has shown 13 cases of category II, and 17 cases of category III. Outcome of these patients was favourable in ten cases for category II and nine cases for category III., Conclusion: If important efforts were realized for classification and diagnostic approach, many patients often fair to respond to treatment.

Gene therapy for Duchenne muscular dystrophy (DMD) will require sustained expression of therapeutic dystrophins in striated muscles. Lentiviral vectors have a relatively large transgene carrying capacity and can integrate into nondividing cells. We therefore explored the use of lentiviral vectors for transferring genes into mouse skeletal muscle cells. These vectors successfully transferred a minidystrophin expression cassette into mdx muscles, and minidystrophin expression persisted and prevented subsequent muscle fiber degeneration for at least 6 months. However, only low to moderate levels of skeletal muscle transduction could be obtained by intramuscular injection of the highest currently available lentiviral doses. Using cultured cells, the lentiviral vectors effectively transduced proliferating and terminally differentiated muscle cells, indicating that cell cycling is not essential for transduction of myogenic cells. We further showed that lentiviral vectors efficiently transduced both primary myoblasts and multipotent adult progenitor cells (MAPCs) in vitro, and the cells persistently expressed transgenes without any obvious toxicity. When mdx primary myoblasts were genetically modified with minidystrophin vectors and transplanted into mdx skeletal muscles, significant numbers of dystrophin-expressing myofibers formed. Finally, we showed that a short, highly active CK6 regulatory cassette directed muscle-specific activity in the context of the lentiviral vectors. The ability of lentiviral vectors to transduce myogenic progenitors using a minidystrophin cassette regulated by a muscle-specific promoter suggests that this system could be useful for ex vivo gene therapy of muscular dystrophy.

Our study justified by the frequency of acute appendicitis and the possibility of anatomic variations of the caecoappendicular area attempt to index the topographic variations of the vermiform appendix (v.a.). On 80 fresh native cadavers (62 men and 18 women) without surgical antecedent whose mean age was 36 years (range between 16 and 78 years) we note the morphotype and the height. More over we study the intraperitoneal projection of the Mac Burney point, topography and shape of the cecum and the situation, shape and dimensions of the v.a. We note also the level of implantation of this latter on the cecum, appearance of the mesoappendix and the distance separating the base of the appendix to the ileo-caecal junction. Mac Burney's point permitted to localize appendix in 66%; the cecum has more often than not the form of a bulb (98.7%) and sited in right fossa iliaca. We noted 7 types of topographic disposition; front varieties were more frequent (68.7%) notably the pelvic direction (51.2%) with a medial (72.5%) or a posteromedial (27.5%) establishment on the cecum. The v.a. was more often in the form of worm with a long mesoappendix; his mean length was 106.4 mm (between 65 and 160 mm) and the mean diameter 6.77 mm (range between 4 and 10 mm). The distance which separated the base of the appendix to the ileo-cecal junction varied between 15 to 40 mm with a mean distance of 24.2 mm. Thus in this study, dimensions of the v.a. were very variables. Located in right fossa iliaca he adopted a front topography with pelvic direction and medial establishment on bulbar cecum. In spite of scarcity of ectopic situation of the appendix for which laparoscopic approach is salutary, a similar topographic study during surgical treatment of acute appendicitis will be interesting.

The authors report a prospective study comparing pre and immediate post operative complications of non complicated hernia of the groin in adult treated by operations based on Bassini and Mac Vay technics. It concerned a total of 100 patients made up of two groups of 50 age ranging from 13 to 84 years with an average age of 47 years of whom were 93 males and 7 females. No mortality was registered. The rate of complications was 20% in Bassini's technic and 22% in Mac Vay's technic. There were: bladder injurie, accidental skin wound incurred by the electric surgical blade, meningeal irritation, urinary retention, scrotal sac hematoma, parietal suppuration, intestinal occlusion and immediate recidivation before 6 months. As well as our study as in literature, specific complications related to both technics were rare. We could draw the conlusion that there is no significant superiority of one technic in comparison with the other one.

Several therapeutic processes were proposed in the repair of incisional hernia, on the basis of simple joining suture go to the installation of prosthetic mesh while passing by aponeurotic autoplasty according to Welti-Eudel technique. The aim of this study was to report the results of our experiment in the treatment of incisional hernias. It was a retrospective study carried out of January 11th 1996 to December 31, 2000, concerning 35 cases of incisional hernias operated during the study period. The following parameters were studied: age, sex, diameter, technique of repair, morbidty, mortality and the remote follow-up. Average age of our patients was 33 years with extremes of 13 and 53 years. It include 30 womens and 5 mens. The initial operation were dominated by Caesarean (57%). The diameter of incisional hernia varied between 3 and 5 cm in 22.9% of patients, between 5 and 10 cm in 62.8% of paitents, higher than 10 cm in 14.3% of patients. The simple joining suture was carried out in 22.9% of cases, the Welti-Eudel technique in 42.9% of cases and the installation of prosthetic mesh in 34.2% of the cases. Mortality was 5.1% and the morbidity was 34.2% made exclusively by suppuration including 5.1% on prosthetic material. We noted 14.3% of recurence which has occured after repair by simple joining. The Welti-Eudel procedure gives good results in the repair of incisional hernia with small and average dimensions. The installation of prosthetic mesh constitute the treatment of choice because the rate of recurence is weak even null.

Study Aim: Sickle cell affection is a public health problem in Africa. The aims of this prospective study were to evaluate the early results of laparoscopic cholecystectomy in sickle cell patients in Senegal., Method: From January 1998 to June 2002 all the sickle cell patients undergoing a laparoscopic cholecystectomy were included. Intra- and post-operative protocol (blood transfusion if Hb < 9 g/dl, rehydration, oxygenotherapy) was standardized., Results: Forty-two patients with sickle cell of types SS-33 and AS9 were operated upon by same surgeon. One case of conversion due to an effraction of biliary junction was reported. One homozygote patient died post-operatively because of peritonitis. Two acute thoracic syndromes, three vaso-occlusive crisis, and two cases of wound infection constituted the post-operative morbidity. No case of complication was noted in those who underwent pre-operative transfusion., Conclusion: Laparoscopic cholecystectomy can be carried out in sickle cell patients with biliary lithiasis provided that general anaesthetic rules are respected.

Our aim was to evaluate practices of percutaneous liver biopsies over the last 11 years in our center in focal or diffuse liver disease. Records of 447 patients who underwent ultrasound-guided liver biopsy between 1998 and 1999 were reviewed. Three experienced physicians performed all liver biopsies with a Menghini needle or fine needle. In all cases the puncture site was determined using prebiopsy ultrasound. Liver biopsies were performed on 423 hospitalized patients and 24 outpatients. The suspicion of primary liver cancer was the indication in 72.7% of the cases. In 75.2% patients definitive or indicative pathological diagnosis were obtained. 208 biopsies out of 229 (90.8%) and 215 cytological punctures out of 239 (89.9%) were interpretable. Histological diagnosis obtained were primary malignamt tumor in 235 cases (58.2%), cirrhosis in 26 cases (6.4%), chronic hepatitis in 32 cases (7.9%), and normal tissue in 56 cases (13.9%). Only 2 hemorrhagic complications requiring blood transfusion (0.4%) and one needle-tract tumor seeding (0.2%) occured 42 months later. We concluded that ultrasound-guided percutaneous liver biopsy is a quick method of assessment increasing the diagnosis yield by this procedure and maintaining low complications.

Our aim were to describe the epidemiological and clinical as well as therapeutical features and to look for predictive factors of occurrence of gastrointestinal hemorrhage among cirrhotic patients. We included all cirrhotic patients with acute gastrointestinal hemorrhage hospitalized in the Service of Internal Medicine of Aristide Le Dantec University Teaching Hospital from January 1990 to December 1999. The diagnosis of cirrhosis was established according to two situations: prebiopsic criteria with clinical, biological, ultrasound and endoscopic data or the histological criteria. Gastrointestinal hemorrhage was present in 28.9% of the patients with an average age of 38.7 years and a sex ratio of 1.4. It revealed the cirrhosis in 82% of the cases, whether alone in 45.2% or associated with other complications in 36.8%. Previous bleeding episodes were found in 76 cases (9.6%). Gastrointestinal hemorrhage is the first cause of death among our cirrhotic patients with an overall mortality of 29.4%. The gastrointestinal hemorrhage was significantly associated with the young age (< 40 years). On the other hand, the clinical and biological parameters did not seem predictive of bleeding. The risk of hemorrhage was positively correlated with the presence of esophageal varices and their stage, the gastric varices and the portal gastropathy. The other lesions (watermelon stomach and erosive gastritis) did not seem to play a role in gastrointestinal hemorrhage. However the CHILD-PUGH classification was a poor predictor of either first hemorrhage or re-bleeding in this present study. We conclude that gastrointestinal hemorrhage is frequent among cirrhotic patients in our country. It constitute in this study the first cause of death in this population. instrumental treatment methods might prevent most of gastrointestinal hemorrhages in patients with high risk.

The aim of this study was to evaluate the short-term results of our therapeutic attitude about the surgical treatment of lower gastric tumours in our departement. It was a prospective study including all patients hospitalized in our department for gastric tumour whose malignancy was strongly presumed by the clinical symptoms, the paraclinical one, the surgical exploration and/or confirmed by histology. Tumours of the cardia were excluded from this study. Laparotomy was carried out among all patients. When the tumour was resecable, we had carried out a lower partial gastrectomy passing at least than five centimeters with the top of the higher limit of the tumour, associated with lymphadenectomy including the first and second relay. This study was undertaken from January 1994 to June 1997 and concerned 39 men and 21 women. Mean age was 57.6 years. The abdominal mass was present in 38.3% of the cases. The histological confirmation for malignancy was obtained in 38.3% of the cases which all were adenocarcinomas. We had proceded to 38% of partial gastrectomy, 54% of gastrojejunostomy and in 8% of the cases no surgical gesture was practised during laparotomy. Morbidity was 13.3% and mortality 21.7%. The average retreat was 12.4 months after partial gastrectomy, 8.3 months after gastrojejunostomy and 3.5 months after laparotomy without gesture. The total rate of surival at one year was 20%. The rate of survival at one year after partial gastrectomy was 39.1%. We recommend partial gastrectomy associated with lymphadenectomy whenever its realization is possible. This surgical attitude associated to early diagnosis could allow a clear improvement of the rate survival in the short and medium term for lower gastric tumors, in our context.

Pheochromocytoma is a catecholamine-secreting neoplasm of chromaffin tissue. The most common symptom is hypertension but there are incidentally discovered forms at imaging. From 1981 to 1998, the authors observed nine pheochromocytomas through three hospitals in Dakar. This study included seven male and two female patients. The average age was 31.61 years. Hypertension was present in 77% of the cases. Headache, palpitations and sweating were the authors most frequent symptoms, occuring in 55% of cases. Measurement of vanillyl mandelic acid level in six cases and urinary metanephrines in three cases made the diagnosis. There were six adrenal and three extra adrenal pheochromocytomas with two malignant tumors features. In our countries, measurement of urinary metanephrines and computed tomography processing may improve detection of pheochromocytomas.

Stabbed penetrating abdominal wounds are becoming more and more frequent in our emergency surgical unit due to increase of aggressions. The goal of our study is to evaluate the conservative treatment of these wounds. This concerns a study carried out between January 1997 and October 1998. Exploratory laparotomy was proposed at each time when one or more of the following criteria was noticed: choc, evisceration of intestines, digestive hemorrhagy or hematuria, outlet of digestive fluids, sign of peritoneal irritation, wounds by gunshots or wounds at the frontal regions. In the other cases, the conservative treatment with wound dressing following an antibiotic and serovaccination therapy of tetanus was the therapeutic option. Our study was carried out on 40 patients of whom were 37 males and 3 females of average age 24.9 years with extremities of 7 to 52 years. It arrived to the following results: 32 of the patients (80%) were victim of aggression and 29 cases were stabbed wounds. The wounds were in the central region (umbilicus 29.5%) and superior to the abdomen and were associated with outlet of the omentum (50%) outlet of the intestines (12.5%), peritoneal irritation (27.5%), digestive hemorrhagy (10%), hematuria (2.5%) outlet of faeces (2.5%). 17 patients (42.5%) underwent exploratory laparotomy on the basis of criteria afor mentioned and the 23 others (57.5%) underwent medical surveillance and 3 of them developed peritonitis and underwent surgery. The rate of negative laparotomy was 5% and retarded interventions was 13%. The morbidity was also 13% and mortality 2.5%. The average period of internship in hospital was 11,4 days with extremities of 1 to 101 days. The conservative treatment of penetrating stabbed abdominal wounds out of the criteria mentioned were quite satisfactory.