Surgical Reports of the Inferior Laryngeal Nerve and the Inferior Thyroid Artery in General Surgery and in ENT

Aim: The purpose of this study was to determine the frequency of the hurts of the inferior laryngeal nerve, according to its anatomical reports with the inferior thyroid artery during the thyroid surgery. Methodology: We realized a forward-looking and retrospective study from January, 1979 till December, 2017 in the service of surgery “B” to the University hospital of the Point G of Bamako and in the service of ENT and cervico-facial surgery of the Teaching Hospital “Mother-Child”, the Luxembourg of Bamako (Mali). All the patients operated in both services for mild goiters were retained. Cancers and other thyroid pathologies were not included. The diagnosis of mild goiter was paused by the histological examination realized on all the surgical specimens. Results: On 2109 dissections of the inferior laryngeal nerve realized during the surgical operations on the thyroid, the frequency of lesion of the inferior laryngeal nerve was 1.09% (20 cases) when it passed dorsally with regard to the inferior thyroid artery (1837 cases) and when 4.04%, it was transvascular or prevascular (272 cases). Conclusion: The prevascular route or transvascular of the inferior laryngeal nerve favors its lesion per operating.

Premature Division of the Inferior Laryngeal Nerve in Surgery and in ENT and Cervico-Facial Surgery in Mali

The purpose of this study was to study the frequency of premature division of the inferior laryngeal nerve and its consequences in thyroid surgery. Methodology: We realized a forward-looking and retrospective study from January, 1979 till December, 2017 in the service of surgery B to the University hospital of the Point G of Bamako and in the service of ENT and cervico-facial surgery of the CHU “mother-child”, the Luxembourg of Bamako (Mali). All the patients operated in both services for mild goiters were included. Cancers and other thyroid pathologies were not included. The diagnosis of mild goiter was paused by the histological examination realized on all the surgical specimens. Results: On 2109 dissections of the lower laryngeal nerve realized during the surgical operations on the thyroid 95.1% of the cases, the nerve had a single branch;in 4.1% of the cases, the nerve had two branches;and in 0.8% of the cases, the nerve had more than 2 branches. Conclusion: The complications of the thyroid surgery in touch with the hurts of the lower laryngeal nerve are known. However, our study shows that these do not seem to be influenced by the premature division of the lower laryngeal nerve.

Anatomy of the Gall-Bladder in the Ultrasound about 1000 Cases

Aim: The aim of this work is to determine the dimensions and the capacity of the gall-bladder by ultrasound. Methodology: We realized a descriptive study over 2 years (from January, 2015 till December, 2017). It concerned an ultrasound exploration of the gall-bladder. The studied population was healthy voluntary subjects visible and on an empty stomach for 12 hours, without history of abdominal trauma and abdominal operating scar. The carrying subjects of the tracks of abdominal trauma or of abdominal operating scar were not included. Results: The average age was of 39 years ± 12.16 with extreme of 10 years and 89 years. It was 500 women (50%) and of 500 men (50%) with a sex ratio of 1. To 450 subjects (45%) the width of the gall-bladder of the subjects varied between 21 and 30. The average was 22.63 mm ± 7.9. Extremes were from 9 to 55 mm. The measurements made by the three sonographers showed no significant difference. The sensitivity of ultrasound in the visualization of the gallbladder was 100%. The length of the gall-bladder was between 61 and 70 mm. The average was 65.35 ± 14.48. Extremes were 26 and 142 mm. Conclusion: This original study shows the normal dimensions of the gall-bladder to Malian.

Anatomy of the Brachial Plexus:A Rare Variation in the Laboratory of Anatomy of Bamako(Mali)

The brachial plexus (BP), established by the lap twigs of the last four cervical nerves and the first thoracic nerve, assures the driving and sensory innervation of the thoracic member. We bring back a case of rare anatomical variation of the brachial plexus. It is a 34-year-old corpse dissected in the laboratory of anatomy of the Faculty of Medicine and Odontostomatology of Bamako in September 2017. The lap twig of the fourth cervical root (C4) participated in the constitution of the brachial plexus. The superior trunk was normally constituted. The average trunk was formed by the cervical roots C7 and C8 instead of only C7. And consequently the inferior trunk was constituted by the thoracic root T1. The posterior beam was only formed by the posterior branches of the superior and more average trunk. The medial beam was formed by all of the inferior trunk which did not give posterior branch for the formation of the posterior beam. The variations of the brachial plexus could entrain failures in the loco regional anesthesia of the brachial plexus.

Morphometry of the Portal Vein:Ultrasound Anatomy about 1000 Cases

Aim: The aim of this study is to determine from a series of 1000 cases the usual dimensions of the portal vein according to the medical ultrasound. Methodology: We realized a transverse study over 2 years (from January 2015 to December 2017). It concerned an ultrasound exploration of the portal vein. The studied population was healthy voluntary subjects visible without history of abdominal trauma and abdominal operating scar. Results: The average age was 39 years ± 12.16 with extremes of 19 years and 70 years. The decade of 21 - 29 years represented 46.2%. The transverse diameter of the portal vein in its origin varied between 8 and 10 mm in 57.9% of the cases. The average was 9.05 ± 2.82 mm with extremes of 5 and 16 mm. The transverse diameter of the portal vein in its ending varied between 8 and 10 mm in 56.9%. In 29.8% of the cases, the length of the portal vein was between 61 and 70 mm and in 8.8% between 81 and 100 mm. The average length was 58 ± 22.3 mm. Before its penetration in the liver, the portal vein divided into 2 branches in 967 cases (96.7%) and in 3 branches in 33 cases (3.3%). Conclusion: This original study shows the normal dimensions of the portal vein to Malian.

A Rare Anomaly of the Left Renal Vein in the Laboratory of Anatomy of Bamako(Mali)

Aim: The purpose of this work was to describe the left renal retro-aortic vein. Methodology: A case of left renal retro-aortic vein was discovered on a corpse of male, 45-year-old adult during the dissections to the laboratory of anatomy of the Faculty of Medicine of Bamako. The way at first was a xypho-pubic median and two side abdominal sections under costal and inguinal. The side sections under costal went of the median section to sides by following the costal edge. The inguinal side sections went of the median section to the anterior and superior iliac thorns. The abdominal wall was opened and reclined by every quoted. The small intestine and the colonist were resected with their meso. The renal pedicle was dissected on each side. The abdominal aorta and the inferior vena cava were dissected by the diaphragm up to the headland. Arteries and iliac veins were also dissected. Results: On male corpse, 45 years old, we discovered a left renal retro-aortic vein in horizontal route, and the trunk of the left renal vein was formed by the confluence of three veins at the level of the left renal hilum. The left renal vein passed almost horizontally below the left renal artery. It passed then behind the abdominal aorta to end in the inferior vena cava at the level of its left side face. The right renal vein had a normal aspect. Conclusion: The left renal retro-aortic vein is one of the variants of the anomalies of the system cellar inferior. The left renal retro-aortic vein could be responsible for renal aplasia.

Epidemiological and Therapeutic Aspects of the Vaginal Hydroceles

Purpose: Our purpose was to describe the epidemiological and therapeutic aspects of the vaginal hydroceles. Methodology: It was a forward-looking and descriptive study of Mars 2014 in July, 2017, which realized in the service of general surgery of the Reference Health Center of Kati (Mali). All the patients operated in the service for hydrocele were included. Other causes of big stock exchange and hydroceles operated outside our service were not including. Results: We operated 92 hydroceles or 5.9% of the surgical activities of the service. The average age was of 34.5 years with extremes of 2 years and 82 years. The most frequent signs of hydrocele were the big painless stock exchange (100%);a transillumination positive (90%) and the effusion of the vaginal in the ultrasound (100%). The cure of hydrocele was realized according to the techniques of Bergmann (94.6%) and of Lord (5.4%). The mortality was nil and the morbidity was 3.3% (2 operating infections of the site and 1 bruise). Conclusion: The hydrocele is a frequent pathology in Africa. The therapeutic strategies are multiple and varied. However, we prefer the Bergmann technique, which is easy, fast and has few complications.