BACKGROUND: Tetanus is a life threatening infection relatively uncommon in the developed countries but occurs frequently in developing countries with case fatality rates of 40-60 %. Recent review of adult tetanus at the Korle-bu Teaching Hospital showed a high case fatality of 50%. In order to determine the factors underlying this high case fatality we conducted a retrospective clinical audit of the clinical management of adult tetanus admitted in 1994 to 2001 to the Korle-bu Teaching Hospital. METHODS: Data extracted from the admission and discharge books of the Fevers' Unit of Korle-bu Teaching Hospital, Accra and patient case notes were examined and analysed. RESULTS: Case fatality rate (CFR) varied from 25 % in 1999 to 72.7% in 2001. There was no gender difference in the case fatality. There was no significant difference in the mean age of those who died and those who survived, however, the CFR rose with age. The presence of neck and a dirty wound were associated with increased CFR. The CFR correlated with the severity of tetanus and increased when an expected treatment action, wound debridement, administration of antibiotics and/or immunoglobulin, was not performed. The administration of anti-tetanus toxin was associated with an increased CFR. CONCLUSION: The high case fatality rate in Accra was due to inappropriate management with most of the patients not treated with immunoglobulin and antibiotics and had inadequate wound care.

Adolescent↗

PubMedDate not supplied

[Current therapeutic orientations for malignant teratomas of the testis with a choriocarcinomatous element. 14 cases (author's transl)].

In teratomas with a choriocarcinomatous element, the association with surgery of sequential chemotherapy lasting at least two years would appear to represent an improvement. Definitive conclusions may only be drawn from the study of large series.

Adolescent↗

PubMedDate not supplied

[Cataract surgery in Togo].

Cataract remains a major cause of blindness in sub-Sahara and a major public health problem. Blindness prevalence in Togo is equal to 1%, more than half of it is due to cataract, while the number of cataract surgeries is low because of the lack of resources. We assessed the eye healthcare in Togo by cataract surgery. The aim was to estimate the number of cataract surgeries and the Cataract Surgery Rate (CSR) in the administrative regions. The demographic data (denominator) was collected from the Demography and Health Survey (1998) while the number of cataract surgeries (numerator) was obtained from medical registers. The Cataract Surgery Rate (CSR, operated cataracts per million) was assessed from 1995 to 2001. From 1995 to 2001, 3,885 cataract surgeries were performed. Public services predominated with 53.03% (n=2061) of the cataracts operated followed by confessional hospitals with 37.1% (n=1443) and private clinics 3.4% (n=143). Decentralised eye healthcares provided 241 cataract extractions. The University hospital centre of Lome Tokoin was the leader, with 32.5% (n=1,262) of operated cataracts followed by the confessional hospital of Glei, 27.2% (n=1,058). The average per centre per year was 43 cataract surgeries. The mean CSR was 126 and varied from 52 to 163 cataract surgeries per million people per year. There was an important concentration of cataract services in Lome where 41% (n=1,586) of cataracts were operated and the CSR was 334. The unequal distribution of cataract services (41% in Lome) leaves many regions without any resources. Since 1999, the CSR increased by 37% in 2000 and 14% in 2001. The Togolese eye healthcare system is poor and substantial further efforts are necessary to make it accessible and affordable to all those in need. This may be the way to reduce cataract surgery barriers and the unacceptable high prevalence of operable cataract blindness.

Blindness↗

PubMedDate not supplied

[Vesicovaginal fistulas: etiopathogenic and therapeutic aspects in Senegal].

Obstetrical vesico-vaginal fistulas are still very common in developing countries, because of to the difficulties of medical facilities. From a series of 123 cases recorded during 6 years, we analyse their epidemiological, anatomo-clinical, and therapeutic aspects. A simplified classification is purposed.

Adolescent↗

PubMedDate not supplied

[Acute periurethritis: 155 cases].

Severe complications of urethral stricture, acute peri-urethral phlegmon can be localized or diffuse. They are characterized by polymicrobial infections. The mortality rates about 7% is the privilege of diffuses forms. The treatment associates medical and surgical procedures, and consists in polyantibiotherapy and excision of suppurative lesions. From a series of 155 cases we analyse the pathogenical, clinical and therapeutical aspects.

Adolescent↗

PubMedDate not supplied

[Uretero-vesical injuries during pelvic surgery in women].

Injuries to the ureter and the bladder are common complications in female pelvic surgery. Unfortunately, they remain often unrecognized per operatively. Intravenous pyelography and renal ultrasonography are very efficient for post operative diagnosis. The indications of nephrectomy have became rare because of the efficacity of the procedures of plastic and reconstructive urological surgery.

Adnexa Uteri↗