Knowledge Practical Attitude of Health Professionals on Breast Cancer at the Hospital of the District of the Commune IV of Bamako

Introduction: The level of knowledge and attitude of health professionals about breast cancer are important determinants. General objective: To study the knowledge, attitude and practice of health professionals of the hospital of the district of the commune IV on breast cancer. Methodology: This was a cross-sectional, prospective, descriptive, qualitative and quantitative study. The study period was from 01 October 2022 to December 2022. Results: In one week of survey, 110 health workers (intern, obstetrician nurse, general practitioners and specialists) received the survey sheet, 80 health workers informed it, a participation rate of 73%. The male sex was most represented at 63.75% with a sex ratio of 1.76. The average age was 39.59 years with extremes of 22 and 61 years. The clinical signs evoked by the participants were: breast nodule (81.25%), followed by breast discharge (48.75%). In relation to risk factors: interns and obstetrician nurses had no good knowledge, 51.72% of general practitioners had good knowledge, 43.48% of specialist doctors had good knowledge, and 5.88% of the wise had good knowledge. Conclusion: Breast cancer is a common pathology around the world, health professionals are at the forefront of the fight against breast cancer, and this fight cannot be effective without trained personnel.

Liposarcoma Retro-Peritoneal in the General Surgery Department of the Hospital of the District of the Commune IV

Retroperitoneal soft tissue sarcomas in the retroperitoneal/intra-abdominal regions represent 10% - 15% of all cases of soft tissue sarcoma. Liposarcomas, which are the most common histological type, account for 20% - 45% of retroperitoneal/intra-abdominal sarcoma cases, and 20% of liposarcomas cases are primary retroperitoneal liposarcomas. Surgical resection in case of malignancy remains the treatment of choice for liposarcomas, according to the guidelines of most major international companies. Our goal was to improve the management of retroperitoneal liposarcoma. This was a 65-year-old patient, with no medical or surgical history, who was referred to us for abdominal swelling, in whom clinical and paraclinical examination found retroperitoneal liposarcoma stage IV, and the surgical treatment consisted in making a tumor reduction. Conclusion: Retro-peritoneal liposarcoma is an undervalued malignant tumor, and the diagnosis is often late.

Fracture of the Humeral Palette in Adult Patient: Therapeutic and Evolutive Aspect at Gabriel Touré Hospital: About 35 Cases

Introduction: Fractures of the humeral pallet occur between the distal insertion of the anterior brachial muscle and the joint space of the elbow. It represents 2% of all elbow fractures. These lower humeral fractures present a therapeutic challenge to trauma. These fractures are in the majority of joint cases and can be accompanied by loss of substance, which makes their functional prognosis random despite the application of the main therapeutic principles: exact reduction with possible bone graft;stable osteosynthesis, usually allowing early rehabilitation. This work focused on identifying therapeutic aspects and assessing treatment outcomes. Material and Methods: This was a descriptive cross-sectional study of patients with a fracture of the humeral palette from January 2015 to December 2019 at the Orthopaedic Trauma Department CHU Gabriel Touré Bamako. Results: We collected 35 cases of fractures of the humeral palette. The average age was 39.25 years with extremes of 22 and 74 years. The male gender predominated (71.4%) with a sex ratio of 2.5. Etiologies were dominated by falls with 19 cases (54.3%) and stroke with 13 cases (37.1%). The standard X-ray of the face and profile of the elbow was performed in all our patients. The most frequent types of anatomoradiology were supra condylar fractures type A in 16 cases (45.7%), supra and inter condylar fractures type C in 15 cases (42.9%);4 cases of uni condylar fractures type B (11.4%). Associated lesions were observed in 42.85%. Surgical treatment was performed in 80% of cases. Complications were dominated by elbow stiffness in 18 cases (51.42%), secondary displacement in 5 cases (14.28%), ossifications in 4 cases (11.42%). At an average decrease of 3.2 years our results were considered good in 45.7%. Conclusion: Fractures of the humeral palette are relatively common with associated lesions. The complexity of the fracture with associated lesions makes treatment difficult with unpredictable evolution.

Inguinal Hernia in Adults: Diagnostic and Therapeutic Aspects at Cs Ref CI Bamako Mali

The inguinal hernia is a very frequent surgical pathology in the world and it represents 95% of the hernias of the groin. This work aimed to determine the frequency of inguinal hernias, describe the clinical and therapeutic aspects of inguinal hernias, describe the morbidity and mortality related to inguinal hernias and evaluate the cost of treatment. Our study was conducted from January 2010 to December 2010 in the general surgery department of the Reference Health Center of Commune I in the district of Bamako. We collected 130 cases of inguinal hernias with a sex ratio of 15.25 in favor of the male sex. The mean age was 48.02 years (standard deviation: 17.53 years). Strangulated inguinal hernias accounted for 4.9% of abdominal surgical emergencies and 14.6% of all operated inguinal hernias. More than half of the patients (82%) were operated under local anesthesia. Clinical signs were marked by painless or irreducibly painful inguinal swelling. The diagnosis was clinical in all patients. Some patients benefited from a minimum blood assessment (rhesus grouping, glycaemia, hemoglobin level and hematocrit). The Shouldice technique was performed in 68% of patients. One case of organ resection was performed, i.e. 0.8% of cases. Morbidity was 4.6% due to wall abscess;0.8% scrotal hematoma type. We have not recorded any recurrence or death.

Complete Ureteral Duplicity Complicated by Lithiasis with Right Ureterohydronephrosis with Left Renal Excretion Defect: Apropos of a Clinical Case

Ureteral duplication is a congenital malformative uropathy that occurs most often in children. Complete ureteral duplication is defined by a kidney that has two ureters with two orifices that communicate to the bladder through two ureteral meati. It is an anatomical variant that remains rare. Its early discovery is due to a lack of diagnostic means, hence the occurrence of long-term complications. To this end, we observe an increased importance of the morbidity linked to the late diagnosis of this duplicity. Our objective was to show the importance of the morbidity linked to the late diagnosis of this anomaly, the incidence of the infection and the complications that this pathology poses as a problem. It was a clinical case of fortuitous discovery taken care of by a general surgeon in the general surgery department of the hospital “Mother Child” Le Luxembourg Bamako Mali. We report a case of complete ureteral duplication complicated by ureterohydronephrosis on a lithiasis wedged in the uretero-vesical junction of one of the left ureters in its lower portion which required a uretero-lithotomy with bladder reimplantation of the left ureters and secondly to a uretero-lithotomy with bladder reimplantation after two months. The postoperative course was simple.

Giant Lactant Adenoma: About a Case

Affecting young women, lactating adenoma is a rare benign tumor of the breast. It is seen mainly in the third trimester of pregnancy and in the postpartum period. Clinically, it is a solid mass, mobile typically benign but its character of rapid evolution is reminiscent of phyllodes tumors, sarcomas and galactoceles. The definitive diagnosis is histological. We report a case of lactating adenoma in a 26-year-old lactating woman, third procedure, second pare, with a history of tumor resection of the outer quadrants of the left breast, 9 months ago, whose histology evoked a fibrotic disease, cystic breast associating non-specific subacute mastitis with suppuration. Received for recurrence of a tumor in the left breast which was the site of a polylobed mass of about 10/5 cm occupying 3/4 of the breast with mobile ipsilateral axillary adenopathies. A micro tru-cut biopsy was performed and the histology was in favor of a lactating breast adenoma with no signs of malignancy. She underwent surgical excision, the consequences of which were simple.

Surgical Management of Recent Traumatic Epiphyseal Fractures-Detachments of the Distal Femur at Gabriel TouréUniversity Hospital

Traumatic epiphyseal detachment fractures of the distal end of the femur are a rare lesion whose severity is linked to disabling sequelae such as limb length inequality or most often axial deviation. In this report, surgical treatment aims to reconstruct the anatomy of the distal femur, to avoid secondary displacements and to allow early mobilization of the knee. Surgery carried out mainly by the technique of plugging in or screwing, opened or better still closed, can be a source of complications including migration of pins, infections, knee stiffness, and growth disorders. The aim of this work was to describe their epidemiological, anatomo-clinical, therapeutic and evolutionary aspects in the Department of Orthopedics-Traumatology at the CHU Gabriel TOURE. It was a retrospective study over 30 months from July 2019 to December 2021. In fact, it concerned 42 patients with traumatic epiphyseal detachment of the distal femur occurring within 21 days or less, on a healthy knee with cartilage fertile treated surgically and followed in the department. However, the diagnosis of traumatic epiphyseal detachment of the distal femur was retained thanks to the clinical examination and supplemented by radiographic images of the knee from the front and from the side. The treatment was surgical. The functional results were evaluated according to the functional criteria of the Eastern Orthopedic Traumatology Society (SOTEST). Forty-two patients included 32 boys and 10 girls of average age of 12 years with extremes of 8 years and 16 years. The lesions were classified according to the Salter Harris classification. We noted 24% type I (n = 10), type II 71% (n = 30), type III 2% (n = 1), type IV 2% (n = 1). Union was achieved in all patients within an average of 6 weeks with extremes of 4 and 12 weeks. The functional result was considered good in 20% of cases and very good in 80%. Traumatic epiphyseal detachment fractures of the distal end of the femur are a rare lesion whose severity is linked to disabling sequelae such as limb length inequality or most often axial deviation. Surgical treatment aims to reconstruct the anatomy of the distal femur, to avoid secondary displacements and to allow early mobilization of the knee.

Traumatic Digestive Perforation in the Hospital of Sikasso: Epidemio-Clinical and Therapeutic Aspects

Traumatic digestive perforation is the pathological opening of the wall of a hollow organ of the digestive tract (esophagus, stomach, small intestine, large intestine, rectum, and extrahepatic bile ducts) following trauma. Injuries to the digestive viscera, especially from trauma, have been known since antiquity. Aristotle recognized that a slight blow can cause an intestinal injury. Perforation of a hollow organ of the digestive sphere results in peritonitis, which in this case is the consequence of an infection of the peritoneal cavity by spreading of the digestive contents. The aim of the work was to describe the epidemiological, clinical and therapeutic aspects of traumatic digestive perforation. Patients and method: The study was retrospective and descriptive from January 1, 2016 to December 31, 2020, in the general surgery department of the hospital of Sikasso (Mali). Patients operated for traumatic digestive perforation were included. Results: The clinical records of 42 patients were collected. Traumatic digestive perforations represented 12.3% of patients hospitalized for abdominal trauma. The average age of the patients was 26.6 years, with a sex ratio of 6:1. The most frequent etiology was road traffic accidents with 38% of patients. The average delay of consultation was 5 days. Abdominal pain was present in 38 patients, vomiting in 17 patients. On physical examination, the most frequent signs were abdominal contracture in 61.9% of patients, and disappearance of pre-hepatic dullness in 54.7% of patients. On rectal examination, the douglas was bulging and painful in 21 patients. X-ray of the abdomen without preparation showed pneumoperitoneum in 54.1% of patients. Excision, suture and peritoneal lavage were performed in 31 patients. The postoperative course was marked by parietal suppurations in 5 patients, a digestive fistula in 2 patients and 4 cases of death (9.5%). Conclusion: Traumatic digestive perforation is a frequent pathology in surgery. Road accident was the main cause. The treatment is essentially surgical.

Stomach Cancer in the General Surgery Departement at the Teaching Hospital Gabriel Toure

Introduction: Stomach cancer is a malignant tumor developed at the expense of the gastric wall. Gastric cancer is a common cancer occupying the 5th rank of cancers in the world, or 5.7% of all cancers. Purpose: To study epidemiological, diagnostic, therapeutic, and prognostic aspects of stomach cancer. Methodology: This was a retrospective and prospective study, which was carried out in the General Surgery Department at the teaching hospital Gabriel Touré between January 1, 1999, and December 31, 2020, and all cases of stomach cancer were confirmed by histological examination. Result: We recorded 857 cases of stomach cancer or 40.1% of digestive cancers. The sex ratio was 1.6. The average age was 55 years ± 13 years. The main clinical signs were epigastralgia (98.6%), vomiting (93.34%), weight loss (96.03%), and anorexia (46.1%). It was adenocarcinoma (97.55%), and antropyloric location (78.64%). Patients were Stage IV (72.817%) cases. Among the 857 patients, 722 were operated on, accounting for 84.25% of the cases. Surgery was palliative in 60.66% and curative in 25.62%. Gastrectomy of 4/5 plus D2 type curage was the most performed in curative surgery. The median overall postoperative survival was 5 months. Conclusion: Stomach cancer is the most common digestive cancer in our department, the diagnosis is most often late, so palliative surgery occupies an important place.

Case of Incomplete Ureteral Duplication Complicated with Lithiasis and Right Uretero-Hydronephrosis

Ureteral duplication is congenital malformative uropathy that occurs most often in children. Complete ureteral duplication is defined by a kidney that has two ureters with two orifices that communicate to the bladder through two ureteral meati. It is an anatomical variant that remains rare. Its early discovery is due to a lack of diagnostic means, hence the occurrence of long-term complications. To this end, we observe an increased importance of the morbidity linked to the late diagnosis of this duplicity. We report a case of incomplete ureteral duplication complicated by ureterohydronephrosis on lithiasis wedged in the uretero-vesical junction of one of the ureters in its lower portion which required uretero-lithotomy with bladder reimplantation of the ureters. Our aim was to show the importance of the morbidity associated with late diagnosis of this anomaly and the incidence of infection and complications that this pathology poses as a problem. This was a clinical case of fortuitous discovery managed by a general surgeon in the general surgery department of the hospital “Mère Enfant” Le Luxembourg Bamako Mali. The suites were simple.

Benin Goitre in the General Surgery Department at Teaching Hospital Gabriel Touré

Introduction: Goitre is an increase in the volume of the thyroid gland. Goiters may be congenital or acquired, diffuse or nodular, functional or non-functional, benign or malignant. Purpose: The objectives of this work were to study and determine the frequency of benign goitre in the general surgery department of CHU Gabriel Touré, and to study epidemiological, clinical and therapeutic aspects. Patients and Method: This was a retrospective and prospective study conducted in the general surgery department of CHU Gabriel Touré, from January 1999 to December 2019. Included in the study were all patients with benign goiter confirmed in histology, hospitalized and treated in the service. Patients with thyroid malignant tumours, strumite, thyroid tract cyst, cervical abscess and neck trauma were not retained. Socio-demographic, clinical, para-clinical, therapeutic and post-operative aspects were the study parameters. Word processing and tables were done with Microsoft Word and Excel 2016 software. Data analysis was performed with Epi info7 software, the statistical test used was the Khi2 test and a value of P < 0.05 was considered statistically significant. Results: A total of 253 patient files were collected. Thyroidectomy represented 5.02% (253/5036) of surgical procedures. The average age was 42.5 years with a standard deviation of 15.6 and extremes of 13.9 and 76 years. The sex ratio was 8.7 in favour of the female sex. Anterior cervical swelling was the most common reason for consultation with 90.0% (230/253). There were 118/253 cases of euthyroid goiter (46.6%), 132/253 cases of hyperthyroid goiter (52.2%) and 3/253 cases of Basedow’s disease (1.2%). Histology revealed (178/253) cases of micro and macro follicular colloid adenoma (70.3%), (27/253) cases of micro and macro follicular vesicular adenoma (10.7%) and (48/253) cases of micro and macro vesicular hyperplasia. The most performed surgical techniques were subtotal thyroidectomy with a rate of 138/253 (54.5%) isthmo-lobectomy with a rate of 102/253 (40.3%), lobectomy with a rate of 11/253 (4.3%) and isthmectomy 1/253 (0.4%). One-month follow-up was marked by 4 cases of surgical site infection (1.6%), 2 cases of transient hypocalcemia (0.8%). One-year follow-up was simple in 98.4% of cases, we noted 4 cases of keloid. The average length of hospitalization was 3.31 ± 0.1 days. Conclusion: Goiter surgery is relatively common in the general surgery department of CHU Gabriel Touré. Good preparation and better post-operative monitoring could help minimize post-operative complications.

Torsion of Ovarian Tumor in the Elderly: About a Case

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

Abdominoperineal Resection in Rectal Cancer in General Surgery Department at Gabriel Toure University Hospital

The objectives: Were to determine the hospital frequency of abdominoperineal resection (APR);to determine mortality and morbidity rates and to assess oncologic outcomes. Method and patients: We performed a retrospective study between 2008 and 2013 in general surgery department at Gabriel Toure University Hospital (UH) which included all patients admitted for rectal cancer confirmed by pathological examination, and having undergone an APR. Results: We have collected 17 cases which accounted for 65.38% of curative resections of rectal cancer. The sex-ratio was 0.89 and the averageage was 49.53 years. The average tumor distance from the anal verge was 4.59 ± 1.7 cm. All patients had adenocarcinoma of the rectum. The histopathologic grade was well in 7 cases, moderate and poor in 5 cases each. According to the pathologic TNM classification, 13 patients were classified T4, 14 patients N+. APR was associated with hysterectomy and partial colpectomy in 4 cases. The average duration of interventions was 202.06 ± 25.68 minutes. The average duration of hospitalization was 18.24 ± 04.89 days. The postoperative mortality and morbidity rates were 5.88% and 29.42%, respectively. Local recurrence was observed in 6 patients and liver metastasis in 2 patients. The overall survival rate was 37.5% at 2 years and 18.75% at 5 years. Conclusion: APR still occupies an important place in our practice. Our results could be improved by the recent introduction of neoadjuvant radio chemotherapy in Mali.