Biomedical subjects

M Dieng

Publications and source records attributed to M Dieng.

At least 19 recordsLinked to original sources

PubMed2006

Strangulated umbilical hernias in children.

Umbilical hernia is a frequent pathology of the anterior abdominal wall in children. The hernia ring closes usually before 4 years, but a strangulation can occur. It is an exceptional complication according to the literature data. Since this complication is rare, we undertook a retrospective study of these strangulations in a 5-year period from January 1997 to December 2001 at Aristide Le Dantec hospital. We collected 41 cases that underwent emergency surgery operations for strangulated umbilical hernias, which represent about 15% of umbilical hernias operated during the same period. The age range was 8 months to 10 years and the average age was 14 months. All the children were examined within 24 h after the onset of the disease and the surgery was immediately performed. In five cases the bowel was necrosed and perforated and we performed a resection followed immediately by an anastomosis. In the follow up, two children presented wound infections and a hernia recurred in one child. There was no mortality. This study conducts us to question western reports which recommend conservative therapy for umbilical hernia in children.

Child↗

PubMed2006

[Fungal keratitis in an intertropical area: diagnosis and treatment problems. Advantage of local use of polyvidone iodine].

Fungal infection is rarely investigated in keratitis. The authors report five cases of fungal keratitis observed at the le Dantec University Teaching Hospital of Dakar, Senegal, involving two males and three females. Diagnosis was made by examination of smears and cultures of corneal scrapings revealing Candida albicans isolated in four patients and Acremonium strictium in another after 2 or 12 weeks of treatment with antibiotics, antivirals, or steroids. Povidone iodine 2.3% concentrated eye drop was used alone or with an azole for 4 a mean of weeks. All patients presented corneal scars. Fungal keratitis must be considered in presence of torpid corneal ulcer and corneal scraping must be systematically done. Topical povidone iodine alone or associated with azole may be an alternative fungal keratitis treatment in intertropical areas.

Administration, Topical↗

PubMed2006

[Penetrating wound of the abdomen. Profile of the suffering patient at Dakar teaching hospital].

INTRODUCTION: In Senegal, the rate of penetrating wound of the abdomen seems to be in great progression. The purpose of this study was to make a descriptive analysis of the epidemiological data on the patient suffering from a penetrating wound of the abdomen. MATERIAL AND METHOD: It is about a retrospective study performed on a 5 years period from January 1997 to January 2002. This study covered 90 cases of penetrating wounds of the abdomen listed at the emergency department of Dakar teaching hospital. The rate, age, sex, responsible agent, circumstances of the wound, place of the injury, evacuation mode, time of admission and check-up injury were studied. RESULTS: The average absolute rate of the penetrating wounds of the abdomen was 18 cases per year. The average age was about 27 +/- 10 years with 88 men for 2 women. The responsible agent was a knife (87%), a firearm (6%), a broken glass (4%), a bullock horn (2%) and a piece of iron (1%). Circumstances of the injury was aggression (91%), accident (6%), self-mutilation (2%), suicide attempt (1%). Evacuation was done by firemen (60%), by the ambulances of the medical structures (22%), and by private individuals (18%). The average time of admission was 5 hours. Nearly 61% of the wounds were located in the umbilical, epigastric, left hypochondre and left side areas. Wound was single in 93,4% of cases and linear in 71,8% of cases. We noted an exit of epiploon (38 cases), peritoneal signs (13 cases) and a small bowel evisceration (9 cases). The treatment was a systematic laparotomy (68%) and a simple closure of the wound with a good follow-up for any further aggravation (32%). CONCLUSION: The patient admitted at the surgical emergency unit of Dakar teaching hospital for penetrating wound of the abdomen is generally a young man, victim of aggression by knife, evacuated by firemen within 5 hours, which present a single and linearwound in perish-umbilical area with exit of epiploon and/or small bowel evisceration, which would undertaken a surgical operation in 68% of cases.

Abdominal Injuries↗

PubMed2005

[Role of Musca domestica in the transmission of multiresistant bacteria in the centres of intensive care setting in sub-Saharan Africa].

OBJECTIVE: The houseflies (Musca domestica -MD) are involved in the transmission of the diseases of the faecal danger in subsaharan Africa. What is their role in the transmission of multiresistant bacteria in an intensive care setting in Dakar? TYPE OF STUDY: Descriptive, forward-looking. MATERIALS AND METHODS: The study was conducted from May 1 to September 30, 2003. During this period a flytrap was put above every patient carrier of BMR (methicillin resistant Staphylococcus, extended spectrum beta-lactamases-enterobacteria, ticarcillin resistant Pseudomonas). Caught MD were carried to the microbiology laboratory and incubated in heart-brain broth at 37 degrees C for 18 hours. Then selective gelose platers were used for identification of bacteria. Comparison of antibiotic sensitivities of bacteria isolated from MD and from the patients was made. RESULTS: Out of 441 hospitalized patients, 26 were colonised or infected by BMR. Human pathogenic microorganisms were obtained from 99 out of 120 flies. Seventeen of those flies were carried of BMR. Six among these 17 flies had BMR with sensitivity profile and phenotype of resistance identical to those of the patients under the trap with birdlime. More 3 MD carried BMR BLSE not found on our patients. CONCLUSION: This study shows that the MD can carry BMR. Their participation in the crossed transmission, between patients, of multiresistant bacteria in intensive care setting, must be discussed. The eradication of the MD in our Africa subsaharan services must be looked for.

Adolescent↗

PubMed2005

[Aniridia: five case studies].

INTRODUCTION: Aniridia, or congenital absence of the iris, is a rare and severe ocular abnormality. We report five cases diagnosed in our department over the last 5 years and describe our clinical findings and attitude. OBSERVATIONS: The patients were two adults and three children, 8-45 years old at the time of diagnosis. Visual acuity ranged from light perception to 20/50. Aniridia was associated with other abnormalities in four cases: lens ectopy in one case, ptosis in three cases, microcornea in one case, macular hypoplasia in three cases and a pterygium coli associated with a pectus excavatum in one case. All patients had complications: corneal dystrophy in three cases, lens opacities in five cases, elevated intraocular pressure (IOP) in two cases, severe amblyopia with nystagmus or strabismus in three cases. Only patients with glaucoma received IOP-lowering medications. IOP was normalized in both cases and regular controls were instituted for all the other patients. DISCUSSION: Management of aniridia is complex in our regions because patients often consult late, at a stage that involves complications and amblyopia. First-intention surgical treatment of glaucoma is not always justified. CONCLUSION: Only genetic counseling, a close follow-up after an early diagnosis and adapted surgical techniques can improve the visual prognosis of aniridia patients.

Adolescent↗

PubMed2005

[Senegalese experience of orbital cellulitis].

AIM: To show the etiological, clinical, and epidemiological aspects of orbital cellulitis at the ophthalmological clinic of A. le Dantec hospital. PATIENTS AND METHOD: This is a retrospective study conducted from January 1994 to October 2003. Sixty-eight patient records were used. We noted patients' civil status, past medical history, clinical and paraclinical examinations, treatment received before and at admission to the clinic, and progression. RESULTS: The incidence of orbital cellulitis was 8.9 cases per year. The average age of patients was 18 years and the sex ratio 2.78 in favor of males. Patients were hospitalized for a mean of 11 days. The fever was often stopped at admission. All patients had violent retrobulbar pain, associated with inflammatory exophthalmos in 77.8% of cases, and ophthalmoplegia in 67.2%. Two cases of diplopia were noted; 57.5% had sinusitis. Streptococcus was the bacterium found most frequently. In hospital, all patients received three antibiotics (ampicillin, aminoglycoside, metronidazole) and prednisone. In 51.5% of the cases, surgical treatment was necessary. Progression was favorable in 55.88% of the cases. Three patients died and 18 cases of blindness were noted. CONCLUSION: Orbital cellulitis is a young people's disorder with serious complications. This medical emergency requires a combination of effective antibiotics and a corticosteroid. Treating the source of infections is essential to avoid recurrence. In our practice, these three drugs in association in first intention was beneficial without an antibiogram.

Adolescent↗

PubMed2005

[A case report of intrapelvic foetal osseous remains localization after clandestine caused abortion].

A 26 year old women, unmarried, second gesture, primiparous, had been hospitalized in our departement for the management of a hypogastric mass. Ultrasonography had shown: an uterus of normal size, a normal uterine vacuity line with presence of many osseous and fibrous constituents inside the inter-vesico-uterine area, including one femoral osseous of 18,6 mm corresponding to 15 weeks of amenorrhoea. A few months before, the patient had undergone a clandestine caused abortion on a progressive intrauterine pregnancy of 12 weeks of amenorrhoea certified by ultrasonography. It is an exceptional complication of clandestine caused abortion. It gives the opportunity to us to discuss its etiopathogenic mechanism. It also enables us to point out the complications of the clandestine caused abortion and to insist on the need for its prevention.

Abortion, Illegal↗

PubMed2005

[Liver arterial ischemia after cephalic pancreatico-duodenectomy. A case report].

Cephalic pancreaticoduodenectomy is the best treatment for cephalic pancreas cancers. A rare complication is the liver ischemia after the divison of gastroduodenal artery. This complication can occur when a celiac trunk stenosed by the median arcuate ligamentous is not recognised. We report the case of a 40 old woman who underwent cephalic pancreaticoduodenectomy for an adenocarcinoma of pancreas head. There was no complication immediatly. Two weeks later, she presented two episodes of angiocholitis. An abdominal tomodensitometry showed a liver arterial ischemia associated with a celiac trunk stenosis. There was a left hepatic artery wich came from the left gastric artery. Medical treatment of the angiocholitis was successful. Surgical revascularization was not necessary. Nine months after, arterial revascularization by the left hepatic artery and biological hepatic tests were restored. This case report talks about the importance of angioscanner before pancreatic surgery when celiac and mesenteric angiography is not available. Also, it underlines the importance of the gastroduodenal artery occlusion test before his ligation during pancreaticoduodenectomy.

Adenocarcinoma↗

PubMed2004

[Evaluation of the management of omphalocele at Dakar].

Omphalocele is a congenital malformation of the abdominal wall of children, characterized by an ombilical defect living the abdominal organ visible through a translucent amniotic membrana. The goals of this study were to describe the epidemiological, clinical and therapeutic characteristics at the University Teaching Hospital of Dakar. We conducted a retrospective study at the UniversityTeaching Hospital of Dakar from January 1997 to December 2002. Fifty cases of Omphalocele diagnosed at the Unit of Paediatric Surgery of the Department of General Surgery at Aristide Le Dantec Hospital, were included in this study. We described the epidemiological, clinical and therapeutic characteristics of omphalocele. Omphalocele is a condition diagnosed late in boys from poor sphere. The study revealed that weight from birth, omphalocele size, local state, and existance of associated malformation correlated with death rate. The treatment option was a spontaneous epidermisation as described by Grob in the absence of omphalocele rupture wich imposed a primary closure of abdominal wall. The overall death rate was 42%. The improvement of results will need an antenative diagnosis, paediatric reanimation unit wich will notably reduce death rate.

Birth Weight↗

PubMed2004

[Treatment of incisional hernias].

Several therapeutic processes were proposed in the repair of incisional hernia, on the basis of simple joining suture go to the installation of prosthetic mesh while passing by aponeurotic autoplasty according to Welti-Eudel technique. The aim of this study was to report the results of our experiment in the treatment of incisional hernias. It was a retrospective study carried out of January 11th 1996 to December 31, 2000, concerning 35 cases of incisional hernias operated during the study period. The following parameters were studied: age, sex, diameter, technique of repair, morbidty, mortality and the remote follow-up. Average age of our patients was 33 years with extremes of 13 and 53 years. It include 30 womens and 5 mens. The initial operation were dominated by Caesarean (57%). The diameter of incisional hernia varied between 3 and 5 cm in 22.9% of patients, between 5 and 10 cm in 62.8% of paitents, higher than 10 cm in 14.3% of patients. The simple joining suture was carried out in 22.9% of cases, the Welti-Eudel technique in 42.9% of cases and the installation of prosthetic mesh in 34.2% of the cases. Mortality was 5.1% and the morbidity was 34.2% made exclusively by suppuration including 5.1% on prosthetic material. We noted 14.3% of recurence which has occured after repair by simple joining. The Welti-Eudel procedure gives good results in the repair of incisional hernia with small and average dimensions. The installation of prosthetic mesh constitute the treatment of choice because the rate of recurence is weak even null.

Adolescent↗

PubMed2004

[Solitary ulcer of the rectum. Report of two cases treated by the Orr-Loygue technique].

We report two cases of solitary ulcer of the rectum treated by Orr Loygue rectopexy technique in a ten-year period at the Surgery Department of Aristide Le Dantec. The first case is about a 39 year-old female who was constipated since approximately seventeen years and had a rectal prolapse associated later to bloody stools. In 1990, she underwent haemorrhoids surgery operation with unsatisfactory results. After the recurrence of the disease, she was admitted at Aristide le Dantec Teaching Hospital, rectoscopy revealed a solitary ulcer. Orr Loygue rectoplexy technique was performed by laparotomy. In the follow up, there was no complication. The second case is about a 43 years old female who suffered from rectal syndrome since twenty years and had pelvis pains with bleeding and phlegmatic diarrhoeas. The physical examination and biologic analysis showed no particularity. Rectoscopy has revealed a solitary ulcer of the rectum which was confirmed by biopsy. Orr Loygue rectoplexy technique was performed. In the follow-up, there was a recurrence and this was confirmed by rectoscopy. The rectopexy alone does not summurize the therapeutic. A final dyskesia or an associated perineal insufficiency must be integrated in a total therapeutic strategy.

Adult↗

PubMed2004

[HIV associated nephropathy syndrome: a case report in Dakar].

HIV associated nephropathy syndrome ( HIVAN Syndrome ) is a recently identified entity and no study has been done in Senegal. So we report this observation. A 40 years old black patient was admitted for renal oedema syndrome and immunosuppressive signs. The biological investigations noticed a non-pur nephrotic syndrome and severe renal failure. Ultrasonography showed quite normal kidney sizes with hyper echogenicity and dediferenciation. HIV research was positive with 45 CD4 lymphocytes / mm3. This patient had no known causes of nephrotic syndrome ( diabetis, lupus ,amyloidosis.). So the diagnosis of HIVAN syndrome was determined with the clinical features and the bad outcome. We emphasize on the necessity to think about HIVAN in every black patient presenting a quickly progressive non-pur nephrotic syndrome. We expect prospectives studies to describe the clinical signs and the frequency of HIVAN syndrome in Senegal.

AIDS-Associated Nephropathy↗

PubMed2003

[Results of emergengy colectomy in the management of the colon volvulus in Dakar hospital].

PURPOSE: The aim of this study was to evaluate the results of emergency colectomies for the management of colon volvulus. PATIENTS AND METHODS: This retrospective study was undertaken on 50 cases of colon volvulus operated in the Surgical Department of the Aristide Le Dantec teaching hospital of Dakar from January 1994 to December 2000. It concerned 42 men and 8 women with an mean age of 42 years. All patients presented an occlusive syndrome suggestive of colon volvulus, which required a laparotomy, through a xypho-pubic incision. The patients were divided into two groups. Group I concerned 13 patients who underwent an ideal colectomy and group II, 37 patients in whom we performed a colectomy associated with a temporary colostomy with either Bouilly-Volkman procedure (n = 23) or Hartman procedure (n = 14) followed one month later by intestinal continuity restoration. Mortality and morbidity were compared in the two groups. RESULTS: The overall mortality rate was 12% (6/50). The mortality rate was 31% (4/13) in group I and 5 % (2/37) in group II. The overall morbidity rate was 14%. In group I, the morbidity rate was 15 % (2/13) and 13,5% (5/37) in group II. CONCLUSION: In our study the mortality rate was higher after colectomy with primary anastomosis than after colectomy with temporary colostomy followed by secondary anastomosis. We recommend colectomy without anastomosis for the emergency management of the colon volvulus in Africa.

Adult↗

PubMed2003

[Uterine leiomyoma at the surgical department of the Teaching Hospital of Dakar. Report of 140 cases operated in two years].

Uterine leiomyomas due to complications in particular mechanical and haemorrhagic constitute a frequent motive of consultation to the surgical department at the university hospital of Dakar. To precise its epidemiologic, clinical and therapeutic aspects, a prospective study of two years (1995-1996) was made. Hundred and forty patients operated for uterine leiomyoma in our department were brought together. Uterine leiomyoma represent 58.82% of the gynaecological disorders operated to the surgical department. These gynaecological affection constitute 15% of the whole surgical pathology. The edge of age most concern was the decade 49-59 years old. The infertility and the low parity were found in 55.14% of the cases. The average delay of consultation was 39 months. The clinical symptoms amounted it metrorrhagia (72%) abdominal or pelvic pains (77.1%) and increase of the volume of the belly (96.4%). The overall reoperating rate was 3.5%. The pelvic ultrasonography allowed to confirm the diagnosis in 84.28% of the cases. The under umbilical laparotomy (90.9%) was the main surgical way. The sub-total hysterectomy was carried out in 35.72% of the cases. The average duration of hospitalization was 9 days and the mortality 0.7%. Main postoperative complications were parietal abscess (16 cases), evisceration (2 cases) and eventration (2 cases). Histological examination realized in 48.06% of the cases confirmed the diagnosis of uterine leiomyoma in every case. In 17.82% of the cases leiomyoma were associated to another lesion and in two cases it was a neoplasm of the uterine cervix. Uterine leiomyomas are frequent in Dakar. Their often impressive volume and metrorrhagia dominant their occasion of diagnosis. Their sufficiently early diagnosis have to noticeably reduce their radical surgery indications in this benign pathology whose association with cervix uterine cancer stays very rare in our daily practical experience.

Adult↗

PubMed2003

[The Burch intervention: report of 24 patients].

The Burch standard colposuspension consist with the suspension of the bladder cervix and the urethral segment to the pectinate ligament from the vaginal wall, in order to reposition the bladder cervix inside the manometric abdominal pression. The aim of this study was to evaluate our results in this technic. It was a retrospective study including all cases of Burch colposuspension, carried out in our departement. This study covered over one 6 years period, from January 1995 to January 2001. Twenty four patients underwent this type of intervention during the study period. The average age of the patients was 45.4 years old. The natural menopause was noted in 45.8% of the cases. The multiparous patients constituted 95.8% of the cases and the 4.2% were the nulliparous ones. A pelvic surgical gesture was carried out in 16.6% of the cases in patient medical past-history. A dystocic childbirth in the patient medical past-history was found in 20.8% of the cases. The missing rate into post-operative near period (urinary incontinence) was 8.4%, therefore 91.6% of good results was observed. The rate of good results into post-operative late period was 84.2%. The Burch colposuspension provides good immediate post-operative results with very little rate of failure. Nevertheless a delayed degradation of long-term results is usual.

Adult↗

PubMed2003

[Care management of lower gastric tumors at Dakar. Preliminary study of 60 cases].

The aim of this study was to evaluate the short-term results of our therapeutic attitude about the surgical treatment of lower gastric tumours in our departement. It was a prospective study including all patients hospitalized in our department for gastric tumour whose malignancy was strongly presumed by the clinical symptoms, the paraclinical one, the surgical exploration and/or confirmed by histology. Tumours of the cardia were excluded from this study. Laparotomy was carried out among all patients. When the tumour was resecable, we had carried out a lower partial gastrectomy passing at least than five centimeters with the top of the higher limit of the tumour, associated with lymphadenectomy including the first and second relay. This study was undertaken from January 1994 to June 1997 and concerned 39 men and 21 women. Mean age was 57.6 years. The abdominal mass was present in 38.3% of the cases. The histological confirmation for malignancy was obtained in 38.3% of the cases which all were adenocarcinomas. We had proceded to 38% of partial gastrectomy, 54% of gastrojejunostomy and in 8% of the cases no surgical gesture was practised during laparotomy. Morbidity was 13.3% and mortality 21.7%. The average retreat was 12.4 months after partial gastrectomy, 8.3 months after gastrojejunostomy and 3.5 months after laparotomy without gesture. The total rate of surival at one year was 20%. The rate of survival at one year after partial gastrectomy was 39.1%. We recommend partial gastrectomy associated with lymphadenectomy whenever its realization is possible. This surgical attitude associated to early diagnosis could allow a clear improvement of the rate survival in the short and medium term for lower gastric tumors, in our context.

Adult↗

PubMed2002

Endoscopic surgery in Senegal. Benefits, costs and limits.

BACKGROUND: Evaluating the introduction of endoscopic surgery in Senegal may be useful for assessing the role of this technology in developing countries. METHODS: The endoscopic surgery performed at the Hospital Principal and the Hospital Le Dantec, Dakar, from January 1995 to December 2000 was evaluated retrospectively. Operative time, postoperative stay, patients, and hospital costs were compared in samples of 100 patients treated endoscopically and 80 patients treated with open techniques. RESULTS: Altogether, 826 endoscopic procedures were performed (11.6% of elective surgical activity). Of these, thoracoscopic (34%) and laparoscopic (14%) vagotomy, cholecystectomy (21%), fundoplication (12%), and diagnostic laparoscopy (11%) were selected for comparisons. Operative time proved to be reduced by endoscopic surgery except for laparoscopic fundoplication (+40 min). After endoscopic surgery, postoperative hospitalization was 3.7 days shorter, and patient fees were consequently reduced. In 6 years, 87% of the hospital investment (36,000 Euro) was recovered. CONCLUSIONS: Developing countries can benefit from endoscopic surgery. First-world countries might supply staff training.

Cost-Benefit Analysis↗

PubMed2002

[Emergency care in tropical areas: status report based on surgical emergencies in Senegal].

Management of surgical emergencies in Senegal is characterized by a mismatch between supply of facilities and demand for care. The situation has been complicated by runaway urban growth. Two situations can be distinguished in rural zones and in the major city of Dakar. The common features in both locations are chronic underfunding, absence of pre-hospital emergency and rescue services, and inadequacy of health care facilities to manage emergency situations. In urban and rural areas, hospital are oversollicited, poorly designed and managed in terms of infrastructure and equipment, and understaffed in terms of surgeons and qualified paramedical personnel. The main differences between urban and rural areas involve the volume and type of surgical emergencies with a constantly increasing number of trauma emergencies in cities. Solving these problems will require a specific national plan to develop emergency care services in general. This plan will require coordination of funding, re-organisation of hospital facilities, and hiring and training of qualified personnel (surgeons and paramedical staff).

Delivery of Health Care↗