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Introduction : les personnes âgees fragiles de plus de 75 ans ont de plus en plus recours aux services d’urgence ; leur etat de fragilite conduit souvent a des situations d’agitation qui soulevent des questions de prise en soins particulierement complexes.Objectif : comprendre la situation des personnes âgees, fragiles et agitees dans les services d’urgence et examiner la possibilite d’ameliorer la qualite des soins avec l’intervention d’une infirmiere de pratique avancee. Methode : etude exploratoire, descriptive qualitative, s’appuyant sur la realisation de neuf entretiens semi-directifs aupres de professionnels intervenant aux urgences et sur l’observation de situations de soins dans ces services. L’analyse est fondee sur l’elaboration d’un arbre thematique et l’examen de la signification des phenomenes observes.Resultats : cinq themes emergent des entretiens : definition de l’agitation, causes et facteurs favorisants, consequences, risques pour la personne âgee et impact sur les soins. Les contenus des entretiens permettent d’identifier la signification du phenomene, le lien entre agitation et fragilite, les difficultes et les mesures possibles permettant d’ameliorer la prise en charge.Discussion : les resultats rejoignent ceux de la litterature et permettent a l’infirmiere de pratique avancee d’identifier sa contribution a la gestion de ces situations complexes.Conclusion : la fragilite etant un processus reversible, la pratique infirmiere avancee pourra ameliorer la qualite des soins dispenses aux personnes âgees fragiles et agitees aux urgences.

Purpose: the objective of the work is to determine the testicular regions favorable for the realization of a testicular biopsy without damaging the important vessels. Material and

The purpose of this work is to show the importance of the testicular artery and the deleterious effects of its injury from a literature review. There were 75 papers relating the testicular vascularization during the period from 1949 to 2017, coming from base electronic data. The corresponding articles concerned retrospective and prospective studies, review articles published in journals with editorial board, reading and science committee. These articles were written in French and English. The results show the success rate of the Fowler-Stephens orchidopexy was varied. The testicular artery maintains testicular thermoregulation, has an endocrine and nutrition roles, besides it was the artery of fertility. The intratesticular anastomoses weren’t seen between the testicular, cremasteric and differential arteries to rats, human and other mammalians. The testicular artery is the only artery that irrigates the testicular parenchyma. However, studies have observed extratesticular communications between the testicular, deferential and cremasteric arteries. In conclusion, the testicular artery is the main artery providing blood supply to the testicle. This artery plays an important role from a physiological point of view. Its lesions have important consequences on the functional and structural future of the testicle. This invites the strict respect of this artery during surgery spermatic cord or its environment.

Resume But le but de ce travail est de rechercher le mode de division portale et ses variantes, afin de conforter les bases anatomiques des hepatectomies reglees. Materiel et methodes trente-deux specimens post-mortem, des deux sexes, âges d’1 jour a 65 ans, ont ete disseques. Le trajet de leur veine porte a ete moule par injection de latex ou par injection - corrosion de Rhodopas*. Les moules obtenus ont ete seches et photographies. Resultats neuf variantes du mode de division portale classique ont ete observees, dont 4 n’ont pas ete rapportees dans la litterature. Elles constituent un enrichissement pour l’anatomiste, mais autant d’ecueils pour le chirurgien. Discussion cette etude a mis a jour l’anatomie de la veine porte et de ses variantes de division. Elle a revele 4 types inedits de mode de division qui devraient etre connus du chirurgien pour mieux conduire les hepatectomies reglees.

Resume Les anomalies de la jonction pyelo-ureterale (JPU) sont de plus en plus incriminees dans les affections renales en general et les uropathies obstructives en particulier. Cependant, la base anatomique du mecanisme etiopathogenique de ces uropathies obstructives hautes demeure un sujet de controverse. La presente etude, prospective et microanatomique a pour preoccupation le developpement de la myoarchitecture de la JPU et se propose d’apporter un substratum anatomique au mecanisme etiopathogenique de l’obstruction de la JPU dans les uropathies hautes chez les nouveau-nes et les enfants. Cette etude a porte sur 122 pieces necropsiques issues de 61 corps d’enfants (36 garcons et 25 filles) âges de 0 jour a 30 mois, fixes au formol sale a 10 %. Ces pieces ont ete traitees histologiquement et colorees au Trichrome de Masson (TM) et a l’Hemateine-Eosine-Safran (HES). Dans la tranche d’âge de 0 jour a 1 semaine (soit 35 cas), les fibres musculaires circulaires sont les premieres a se mettre en place. Elles ont une disposition initiale en anneau complet dans 5 cas sur 35 et incomplet dans 5 cas sur 35, associees dans ce dernier cas a d’autres fibres musculaires longitudinales. Les fibres musculaires longitudinales sont davantage retrouvees apres la premiere semaine. Les fibres musculaires longitudinales internes ont ete remarquees dans 14 cas sur 26 et les fibres musculaires longitudinales externes dans 22 cas sur 26. Etant donne la propriete constrictive intermittente des fibres musculaires circulaires, celles-ci devraient etre davantage considerees dans la quete etiopathogenique des uropathies obtsructives hautes chez les nouveau-nes et les enfants.

The aim of this study is to demonstrate the role of spermatic or testicular artery with regard to fertility. 100 male rats Sprague-Dawley, consisted of 50 young rats (aged from 10 to 12 days old) and 50 adult rats were concerned. Unilateral ligation of the testicular artery with delayed controlateral orchiectomy were performed in 20 young rats. Only unilateral orchiectomy was planned in 20 other young rats and the 10 remaining were the absolute control group. Mating was observed for 2 weeks after 14 weeks of life. In adult rats, 20 underwent a bilateral ligation and division of the spermatic artery while 20 others were submitted to unilateral ligation-division associated with controlateral orchiectomy in 20 others. The 10 remaining represented the control group. The mating period was 3 weeks. After sacrificing animals, results were noted with regard to histological features and fertility. Among young rats, 45% were fertile and had normal gonadal tissue. From adult rats, only 10 to 15% were fertile. Atrophic testes were observed in 55% of infertile young rats while acute inflammatory lesions were predominant in most of adults. We conclude that ligation or division of spermatic artery is responsible for histological changes thus occurring in infertility in young and adults rats.

Resume Une etude de la systematisation des shunts arteriels et veineux du penis a ete possible apres injection vasculaire du corps caverneux et spongieux a l’encre de chine gelosee chez le fœtus, le nouveau-ne, l’enfant et l’adulte. Des coupes seriees sagittales et transversales du penis ont ete lues au microscope binoculaire apres transparification, puis photographiees a l’aide du photomicroscope Zeiss. Les arteres caverneuses et spongieuses sont richement anastomosees entre elles et avec celles des teguments correspondants. Sur tout le long du penis, de la racine jusqu’a la fossette naviculaire, les arteres caverneuses profondes deja anastomosees avec les arteres superficielles, donnent des branches perforantes qui vont directement s’anastomoser avec les arteres longitudinales de la sous-muqueuse uretrale toujours accompagnees de 2 veines de calibre plus important ; ces arteres et veines perforantes etablissent un shunt entre les 2 corps du penis. La richesse de ces differentes connections vasculaires et shunts serait le gage de la physiologie de l’erection et du succes de tout acte medicochirurgical mene sur le penis.

Introduction Les nerfs ilio-inguinal ou petit nerf abdomino-genital et ilio-hypogastrique ou grand nerf abdomino-genital sont des branches collaterales longues du plexus lombaire. Tous les deux sont des nerfs mixtes : moteurs et sensitifs. Notre travail est une etude prospective portant sur la dissection et le reperage des nerfs ilio-inguinal et ilio-hypogastrique au niveau de la paroi anterolaterale de l’abdomen : applications pratiques a ete effectue sur 15 cadavres. Materiel et methodes ou observations Notre etude a ete effectuee au laboratoire d’anatomie-pathologique et de medecine legale du centre hospitalier et universitaire de Treichville a Abidjan. Elle a porte sur 60 cas de dissections des nerfs ilio-inguinal et ilio-hypogastrique chez 15 cadavres frais en tenant compte des criteres d’inclusions. Le macchabee est installe en decubitus dorsal, la voie d’abord est cutanee par une triple incision puis dissection. Le reperage de ces nerfs, nous a permis d’effectuer les differentes mensurations. Resultats Les nerfs ilio-hypogastrique sont deux nerfs grossierement paralleles et ayant un trajet et des rapports communs. Ces deux nerfs se terminent soit dans les grands droits pour le nerf ilio-hypogastrique et au niveau genital pour le nerf ilio-inguinal. La dissection et le reperage des nerfs hypogastrique trouvent son interet au cours de certaines kelotomies (appendicectomie, cure herniaire, cesarienne). Des differentes mesures ont ete prises en fonction de la taille et de la corpulence de chaque macchabee. Conclusion La longueur moyenne du nerf ilio-inguinal est de 10 cm et celle du nerf ilio-hypogastrique est de 14 cm. Le calibre du nerf ilio-inguinal varie de 0,5 a 0,9 mm et celui du nerf ilio-hypogastrique de 1,2 a 1,9 cm. Pour l’incision de pfannenstiel, il faut eviter les incisions transversales trop larges. Au total la connaissance du trajet de ces nerfs permet de les eviter au cours des differentes kelotomies.

The developmental anatomy of the striated urinary sphincter remains controversial and is scantly documented in children. We compared its structure and configuration in the fetus, infant and adult to determine anatomical differences among these groups. We removed 25 postmortem specimens from fetuses, infants and children, which were fixed and stained for histological study. Ages ranged from 14 weeks of gestation to 12 years postpartum. Transverse and mid sagittal sections were obtained from the bladder neck to the membranous urethra in male and the whole urethra in female subjects. At the level of the membranous urethra in male and mid urethra in female subjects the striated muscle fibers completely encircle the urethra and join behind it to form a tail-like structure that runs posteriorly towards the perineal body. This structure is mid sagittal in male and mediolateral in female subjects. At 3 to 4 months of life, at the level of the bulbourethral glands the tail disappears; the striated sphincter becomes horseshoe-shaped and its 2 branches bifurcate posteriorly to envelop these glands. The urethral striated sphincter consists of scantly dispersed muscle fibers in the fetus. In young infants it becomes well defined in both sexes with the presence of a tail-like structure that characterizes this age group. In older subjects this tail disappears and the sphincter assumes a horseshoe or omega-shaped configuration as splitting of the sphincter progresses caudo-cranially with development. We attempt to determine whether the ring configuration of the voluntary sphincter contributes to high voiding pressures that are reported to occur in some newborns and infants.

Objective: To analyse the epidemiological features, diagnostic criteria and therapeutic aspects of 41 genitourinary lesions due to pelvic fracture. Patients and Methods : This is a retrospective analysis of 41 consecutive cases of pelvic trauma associated with urinary or genital complications seen over a 5-year period at the University Hospital of Treichville, Abidjan, Côte d'Ivoire. The patients had a mean age of 27.8 years (range: 14 – 48 years) with a male-to-female ratio of 9.25 to 1. Results: Traffic accidents were the prevailing cause of trauma accounting for 75.6%. The commonest type of fracture was anterior arc fracture encountered in 26.9% of the patients. The commonest presenting symptoms were chronic urinary retention (16.7%), bleeding per urethram (10.4%) and hematuria (29.1%). Urethral lesions were encountered in 50%, bladder lesions in 38.5%, lesions of the external genitalia in 9.6% and prostatic lesions in 1.9% of patients. In the majority of the patients (51.2%) urethral repair was attempted by the spatulated anastomotic technique. In cases of disruption of the membranous urethra, urethral repair was delayed by 3 months. The functional results of treatment were good in 66%, while satisfactory erectile function could be achieved in 73% of the patients. Mortality was 4.9%. Conclusion: The prognosis of patients with pelvic trauma can be improved by a fast diagnosis and by resorting to a multidisciplinary team taking care of the multiple visceral injuries in association with the urogenital ones. Résumé Objectifs: Analyser les données épidémiologiques, diagnostiques et thérapeutiques des complications uro-génitales de 41 cas de traumatismes du bassin. Patients et méthode: Il s'agit d'une étude rétrospective effectuée à partir de 41 cas de traumatismes du bassin avec complication urinaire et/ou génitale colligés dans le service d'urologie du CHU de Treichville sur une période de cinq ans. L'âge moyen des patients est de 27,8 ans (extrêmes: 14 à 48 ans), avec un sexe ratio de 9,25 hommes pour une femme. Résultats: Les accidents de la voie publique sont les plus grands pourvoyeurs de traumatisme représentant 75,6% des cas. Les fractures de l'arc antérieur sont les plus incriminées (26,9%). Les signes cliniques les plus évocateurs sont: la rétention aiguë d'urines (16,7%), l'urétrorragie (10,4%) et l'hématurie (29,1%). Nous avons observé 50% de lésions urétrales, 38,5% de lésions vésicales, 9,6% d'atteintes des organes génitaux externes et 1,9% de lésions prostatiques. Nous avons opté pour une réparation à distance du traumatisme causal (3 mois) pour les ruptures de l'urètre membraneux en faisant une large part à la résection-anastomose avec spatulation (51,16%). Nous avons obtenu 66% de bons résultats sur le plan urinaire et 73% de conservation d'une fonction érectile satisfaisante tandis qu'une mortalité de 4,9% assombrit le pronostic.Conclusion: Le pronostic peut être amélioré par la célérité du diagnostic et la prise en charge des lésions qui sont squelettiques et souvent poly-viscérales chez les patients présentant des lésions uro-génitales consécutifs aux traumatismes du bassin, c‘est à dire la nécessité d'une prise en charge spécialisée pluridisciplinaire. African Journal of Urology Vol. 12(1) 2006: 37-43

The aim of this study is to precise the variations of portal vein branches and also to elucidate anatomic basis of partial hepatectomy.Thirty-two post-mortem specimens, with ages ranged from one day to sixty-five years in both two sexes, were dissected. Latex and Rhodopas were used for visualizing and drawing the portal vein course and its branches.Nine types of different variations of portal vein branches were observed. Most of cases were similar to those previously reported in literature. But four types must be especially noted, because they were not available in literature.this study updates the anatomy of portal vein and its tributaries, and also finds out four types of distribution which must be known by surgeons with regards to partial hepatectomy.

The aim of this study is to demonstrate the role of spermatic or testicular artery with regard to fertility. 100 male rats Sprague-Dawley, consisted of 50 young rats (aged from 10 to 12 days old) and 50 adult rats were concerned. Unilateral ligation of the testicular artery with delayed controlateral orchiectomy were performed in 20 young rats. Only unilateral orchiectomy was planned in 20 other young rats and the 10 remaining were the absolute control group. Mating was observed for 2 weeks after 14 weeks of life. In adult rats, 20 underwent a bilateral ligation and division of the spermatic artery while 20 others were submitted to unilateral ligation-division associated with controlateral orchiectomy in 20 others. The 10 remaining represented the control group. The mating period was 3 weeks. After sacrificing animals, results were noted with regard to histological features and fertility. Among young rats, 45% were fertile and had normal gonadal tissue. From adult rats, only 10 to 15% were fertile. Atrophic testes were observed in 55% of infertile young rats while acute inflammatory lesions were predominant in most of adults. We conclude that ligation or division of spermatic artery is responsible for histological changes thus occurring in infertility in young and adults rats.

The levator ano-muscle and fascia are studied by females pelvis. The muscle is composed of three groups of fibres: the puborectalis muscle, the ilococcygeus and the ischiococcygeus muscles. The muscular fascial graft is dissected from the superior fibers of puborectalis muscle and placed in front of the lateral face of the bladder. In this regard, the anatomical and clinical knowledges are provided and morphometric and morphologic studies proposed this graft as the inter-vesico-vaginal plasty in treatment of vesico-vaginal fistulae.

This study investigated the congenital retro-aortic left renal vein in three subjects, observed in dissection practice. Comparative morphometric analysis is made about vein and artery and their collaterals. The importance and the contribution of this left retro-aortic renal vein are discussed with reference to his embryologic and clinical aspect implication.

The aim of this study is to identify in 43 adults African hearts the different arteries of the sinus node. The method used is the injection corrosion technic of the coronary vessels. This study conclude that the right coronary system is the principal way of irrigation of sinus node in Africans (46.6% of cases).

This anatomic study realized on 40 African adults hearts, studies the veins related to the coronary sinus. By using injection of the coronary arteries and corrosion of the myocardium, this study discovers certain particularities of the small coronary vein and of the posterior descending interventricular vein in Africans.

The aim of this study is to identify in 43 adults african hearts the different arteries of the sinus node. The method used is the injection corrosion technique of the coronary vessels. The study concludes that the right coronary system is the principal way of irrigation of sinus node in Africans (46.6% of cases).

This anatomical study carried out on 40 African adults hearts studied branches of the coronary sinus. By using of injection of the coronary arteries and corrosion of the myocardium, the study identified certain peculiarities of the small coronary vein and the posterior descending interventricular vein in Africans.

International audience; Social dispersal is an important feature of population dynamics. When female mammals occur in polygynous groups, their dispersal decisions are conditioned by various female‐, male‐, and group‐related factors. Among them, the influence of disease often remains difficult to assess. To address this challenge, we used long‐term monitoring data from two gorilla populations (Gorilla gorilla gorilla) affected by infectious skin disease lesions. After controlling for other potentially influential factors, we investigated to which extent disease avoidance drives the dispersal decisions of gorilla females. We showed that the infection of a silverback of a breeding group by the skin disease increased the probability of adult females to emigrate. Moreover, adult females avoided breeding groups with a high prevalence of skin disease by emigrating from them and immigrating into healthier ones. Age of the breeding group was also an important factor. Adult females left older groups, near the end of a male tenure, to join younger ones led by younger fully grown silverbacks that could be of high reproductive and protective value. Our study highlights that, although females select for high‐quality males, disease avoidance is a critical driver of their dispersion decision.

15 pages; International audience; We carried out a multidisciplinary study linking behavioral and morphological data from a little-known guenon species, Cercopithecus solatus, endemic to Gabon. Over a period of 9 months, we documented the pattern of stratum use associated with postural and locomotor behavior by direct observation (650 hrs) of a semi-free-ranging breeding colony. We also conducted a morphometric analysis of the humerus and limb proportions of 90 adult specimens from 16 guenon species, including C. solatus. Field observations indicated that C. solatus monkeys spent a third of their time on the ground, similar to semi-terrestrial guenon species. We detected two patterns of stratum use: at ground level, and in trees, at a height of 3–10 m. The monkeys spent more time on the ground during the dry season than the wet season, feeding mainly at ground level, while resting, and social behaviors occurred more frequently in the tree strata. Our study of humerus size and shape, together with the analysis of limb proportions, indicated morphofunctional adaptation of C. solatus to greater terrestriality than previously thought. We therefore characterize C. solatus as a semi-terrestrial guenon, and propose a new hypothesis for the ancestral condition. By combining behavioral and morphological results, we provide new information about the adaptive strategies of the species, and the evolutionary history of guenons, thus contributing to the conservation of the sun-tailed monkey in the wild.

International audience