Results of Femoral Neck Fractures Screwing in Adults at University Hospital of Brazzaville

Purpose: The good of this survey was to analyze the epidemiological aspects and evaluate anatomical and functional results of the treatment by screwing of femoral neck fracture in adulthood at the Teaching Hospital of an underequipped country. Material and Methods: This is a retrospective study from January 1, 2011 to December 31, 2015, concerning patients hospitalized for fractures of femoral neck and having been operated by screwing. The variables studied were epidemiological and therapeutic aspects. Anatomical results were examined on standard x rays of the pelvis in front and the hip in profil, based on the consolidation of the bony axis. Functional results were analyzed according to the quotation of Postel Merle D’Aubigné. Results: Eleven screwings of femoral neck have been done to 11 patients (9 men and 2 women), average age was 47 years (29 and 60 years) from January 2011 to December 2015, at the mean recoil of 19 months (12 and 24 months). Amongst consolidated patients (n = 7), one patient presented a necrosis of femoral head at two years hindsight. Four patients presented an aseptic pseudarthrosis of femoral neck, or a bad anatomical result. Amidst this group of patients, one underwent a joint replacement type Moore and suggestion of intermediary prothesis was recommended to three patients. According to the quotation of Postel Merle D’Aubigné, results were very satisfactory to 5 patients, good to 2 patients and bad to 4 patients. According to the score of Parker, 7 patients presented a score of 9 and 4 patients a score of 7. Conclusion: The treatment of femoral neck fractures in adulthood requires a surgical approach by osteosynthesis and must be precocious before 24 hours in order to reduce risks of pseudarthrosis of femoral neck and necrosis of femoral head.

Epidemioclinical Aspects of Childhood Domestic Accidents in the Emergency Department of Boffa Hospital

Introduction: Domestic accidents are defined as accidents that occur in the home or its immediate surroundings. Objective: To describe the epidemioclinical and therapeutic aspects. Patients and Methods: Prospective, descriptive study from July 1, 2019 to June 30, 2020 in the emergency department of Boffa prefectural hospital included all children aged 0 to 15 years admitted for domestic accidents. Results: Of 120 cases of accidental trauma, 56 were domestic accidents. The mean age was 7.08 years. The 0 - 5 and 11 - 15 age groups were the most represented (35.71%). The sex ratio was 1.55 in favor of boys. Domestic accidents were represented by falls (26.78%), thermal burns (21.43%), snakebite wounds (17.86%) and dog bites (10.71%), drowning (5.36%), and electrification by lightning (3.60%), one case or 1.78% of each of the following: esophageal foreign body by palm nut, firearm, wall collapse, stretching of upper limb. Paracetamol was the molecule most frequently used (89.28%). The outcome was favorable in 92.86% of cases. However, four (4) deaths were recorded. Conclusion: Domestic accidents remain a significant pathology at Boffa prefectural hospital.

Corticosurrenaloma: About a Pediatric Case

Introduction: This study aims to describe the outcome of adrenocortical cancer in children through observation. Observation: A 10-year-old girl with no previous pathological history. She presented headaches and severe hypertension with clinical and biological signs of hyperandrogenism for 6 months. An abdominal CT scan showed an encapsulated left adrenal mass without local or regional invasion or secondary location. A pheochromocytoma or adrenal neuroblastoma was first suspected. The blood pressure was stable at 130/65 mmHg under antihypertensive drugs. She underwent a complete tumor resection without any intraoperative incident. The pathologic study confirmed the adrenocortical carcinoma scored Weiss 7. The severe high blood pressure reappeared 2-year later despite antihypertensive drugs. The thoracic abdominal and pelvic CT scan showed a locally advanced tumor recurrence in the left adrenal gland with parenchymal nodes in the lungs and liver. The outcome was fatal despite medical and surgical management. Conclusion: Adrenocortical cancer is a rare tumor. It is important to hormonal testing in the presence of Cushing’s syndrome in children. It can give a strong indication of the diagnostic possibilities. Histology confirms the diagnosis. The evolution is covered by complications, in particular recurrence with life-threatening metastases.

Practice of Pediatric Neurosurgery at the “Hôpital SpécialiséMère-Enfant Blanche Gomes” in the Republic of the Congo

Introduction: Pediatric Neurosurgery is a growing specialty in its own right worldwide. Its practice in sub-Saharan Africa remains confronted with many challenges, notably the absence of a pediatric neurosurgeon, the lack of a dedicated service and the absence of multidisciplinary pediatric collaboration (neuroanesthesist, neurologist, oncologist and psychotherapist). The objective of this preliminary study is to describe the practice of pediatric neurosurgery at the HSMEBG and to present perspectives for its improvement. Methods: This is a retrospective, monocentric, descriptive study covering the period from March 2021 to March 2022 at the Pediatric Surgery Department of the HSMEBG. Résults: During the study period, 50 children were hospitalized for a neurosurgical condition. The sex ratio was 1.77. The average age was 6 years with extremes of 2 weeks and 16 years. Most children were from the emergency department (46%). Computed tomography (CT) was performed in 35 patients (70%), magnetic resonance imaging (MRI) in 4% and plain radiography in two patients (8%). Malformative, traumatic (cranial and spinal) and tumor pathology were the most frequent with 42%, 36% and 12% respectively. Twenty-six patients were operated (52%). We recorded one postoperative infection (2.5%). The overall mortality was 8% (N = 4). Conclusion: This preliminary study allowed us to identify the epidemiological and clinical profile of the patients treated in our context as well as the therapeutic approach. Malformative pathology remains the most frequent, followed by traumatic and tumor pathology. The development of the practice of this discipline remains a challenge in our working conditions and requires the training of pediatric neurosurgeons and dedicated paramedical staff.

非洲地区的外观畸形儿:在小儿外科影响就诊延迟的因素

Aim:To analyze the attitudes of the Guinean and of the Ivory Coast communities leading to delayed consultation despite apparent malformations in children. Patients and methods:From January 1,2000 to December 31,2002,we carried out a prospective investigation in the paediatric surgery units of the Donka teaching hospital (Conakry) and Cocody,Treichville and Yopougon (Abidjan) teaching hospital. One hundred and two children affected with apparent malformations were included.The studied variables were:age,sex,ethnos group,religion,socio-economic level and the cultural designs of the families.Results:Sex ratio male/female was 1.5 and the average age at first consultation was 17 months. Seventy-six per cent of the children carrying apparent malformations at birth were seen at an age ranging from 1 to 30 months. Orthopaedic malformations were prominent (44%) and led especially to negative reactions of the entourage of the patients. Some religious beliefs took a part of the delayed consultation and impaired relationships between the 2 parents. The low socio-economic level (54%) was determining in the delayed consultation. The birth of a child with malformation in the malinké,akan krou community could be understood like a parchment from a god or a witchcraft. Conclusion:The contributive factors of the delay to the consultation of the children carrying apparent malformations in the communities Guinean and of the Ivory Coast are poverty,ignorance and some religious beliefs. Education and well understanding of these reasons in developing country should improve the acceptance and taking care of these children as well as the development of medical insurance system.

先天性门腔静脉瘘合并肝肺综合征:结扎术与肝脏移植的对比

A 4-year-old boy underwent pulmonary testing for diagnosis of exercise-induced dyspnea and subsequent cyanosis. Findings demonstrated the presence of multiple pulmonary arteriovenous fistulas resulting in oxygen desaturation owing to shunting (PaO2,44 mm Hg). Abdominal ultrasound,abdominal computer tomography,and mesenteric angiography revealed an extrahepatic portocaval fistula (PCF),absence of a patent portal vein,and no evidence of portal hypertension. Because these findings were consistent with hepato pulmonary syndrome (HPS),liver transplantation was initially considered. However,subsequent workup using cavofistulography revealed the presence of a hypoplastic portal vein that selective catheterization showed to be threadlike but patent. Based on this finding,a definitive diagnosis of a congenital PCF with hypoplasia of the portal vein (type 2 Abernethy malformation) was made and surgical ligation with transection of the fistula was performed at the age of 5. Treatment was successful without subsequent development of portal hypertension and pulmonary symptoms disappeared. Follow-up examination 4 years later showed that the boy was asymptomatic and that the intrahepatic portal system was patent with normal hepatopetal flow. This is the first reported case of HPS because of portal type 2 Abernethy malformation. Anatomical types of PCF and corresponding therapeutic options in case of HPS are discussed.

1例范可尼贫血和VACTERL综合征患儿同时出现的双侧肾上腺神经母细胞瘤和肾母细胞瘤

Fanconi’s anemia (FA) is an autosomal recessive inherited syndrome with a predisposition to malignancy. The association between FA and solid pediatric tumors is extremely rare. The authors report a rare case of VACTERL syndrome associated with FA and multiple solid pediatric tumors occurring in a very young girl. This child had numerous congenital anomalies (horseshoe kidney, cerebella hypoplas ia, microcephaly, sacral agenesis) and esophageal atresia, which was repaired in neonatal period. Such association led quickly to the diagnosis of FA. At age of 11 months, she developed simultaneously a renal tumor in a horseshoe kidney and bilateral adrenal tumors. The left adrenal mass was removed, and partial nephre ctomy was performed. Histological analysis concluded to adrenal neuroblastoma and nephroblastoma. We also evaluated the c-kit expression in these tumors to propose a therapeutic alternative to chemotherapy by oral agent STI-571 (Gleevec;Novartis, East Hanover, NJ). Strong cytoplasmic immunostaining of c-kit was found in both tumors. Unfortunately, she quickly developed a posterior cerebellar fo ssa tumor and died 1 month later. This clinical situation is very rare but suggests that young patients with FA and solid pediatric tumors may belong to a particular subgroup of FA. Further studies are necessary to test if STI-571 treatment could be efficient in such patients with pediatric tumors.

对隐睾男童进行超声成像检查是否有用

Objective: To evaluate the accuracy of ultrasonographic examination in boys with an undescended testis. Material and methods: All patients who were referred to the paediatric surgeon after detection of an undescended testis were evaluated prospectively between November 2001 and November 2004. Among these 377 patients, 87 were referred with an ultrasonogram previously prescribed by the referring primary physician. The results of the ultrasonogram were compared to the results of the clinical examination of the paediatric surgeon and, in cases of no palpable testis, to the surgical findings. Results: Ultrasonography did not detect the retractile testes. Ultrasonography detected 67% of the palpable undescended testes. In cases of no palpable testis, the ultrasonographic examination missed the abdominal testes and sometimes other structures were falsely interpreted as a testis. Conclusion: Sonography has no place in the diagnosis of undescended testis.