Objective: Analyze the maternal mortality in the two departments of CHU Point “G” in Bamako, because of high maternal mortality rate in our country. Material and Methods: This was an analytical cross-sectional study...Objective: Analyze the maternal mortality in the two departments of CHU Point “G” in Bamako, because of high maternal mortality rate in our country. Material and Methods: This was an analytical cross-sectional study on maternal deaths from February 19, 2005 to November 19, 2019 for patients admitted in both departments and who died during the pregnancy-puerperal period at CHU Point “G”. All the patients who died outside this pregnancy-puerperal period were not retained. The data were entered and analyzed using SPSS 12.0 software. The statistical test used was that of Chi2, the statistical significance threshold was fixed at 5%. Results: During our study, we recorded 389 maternal deaths out of 16,033 admissions in 15 years and 18,060 live births during the same period making a maternal mortality ratio of 2153.931 and a frequency of 2.426. At the end of our study, we noted that the frequency of maternal deaths was higher in 2014: 12.9% (50/389). The maternal death predominantly affected women aged of 20 - 24 with a frequency of 22.4% (87/389). The multiparity (166/389 making 42.7%), illiteracy (341/389 making 87.7%), the poor evacuation conditions (non-medicalized transport): 263/389 making 67.6%;the evacuation without any evacuation sheet: 259/389 making 66.6%), poor CPN (Prenatal consultation) quality (undone CPN: 191/389 making 49.1%) and the poor monitoring of delivery works (no use of partograph in 343/389 making 88.2%) were the factors favoring maternal deaths. The main causes of maternal deaths were direct in 231/389 making 59.4% with hemorrhage in first line: 21.1% (82/389), infection (61/389 cases making 15.68%), dystocia: 50 cases making 12.85% and high blood pressure and complications (38/389 making 9.76%);indirect in 158/389 cases making 40.6% (Figures 1-3). The majority of women 65.8% (256/389) of our patients died in the gynecology and obstetrics department;in the Resuscitation department 73/389 making 18.8%;in the operating room 43/389 making 11.1% and the deaths that were observed on arrivals represented 17/389 making 4.4%. In our study, 10.3% (40/389) of our patients died in the antepartum, 57.1% (222/389) in perpartum, and 32.6% (127/389) in the postpartum (Figure 4). The need not covered in blood transfusion represented 91.5% the cases either 356/389. Conclusion: The frequency of maternal deaths is very high in our country. Reducing the rate of maternal deaths requires improving the SONU (cares obstetrical and neonatal emergency).展开更多
The sigmoid volvulus is an acute strangulation of the colon by the twisting of the sigmoid loop around its mesenteric axis resulting in partial or complete obstruction of the colonic lumen. It is the most common intes...The sigmoid volvulus is an acute strangulation of the colon by the twisting of the sigmoid loop around its mesenteric axis resulting in partial or complete obstruction of the colonic lumen. It is the most common intestinal volvulus and is an absolute medical and surgical emergency. Objectives: Determine the frequency of sigmoid colon volvulus, describe clinical and para-clinical signs, describe treatment, and determine morbidity and mortality. Methodology: This was a retrospective and prospective study performed in the General Surgery Department of Sikasso. This study concerned patients admitted and operated for sigmoid volvulus from January 1, 2014 to December 31, 2017. Retrospective Phase: We have created survey cards to study the following parameters: 1) The age and the sex;2) The clinical signs and associated defects;3) The radiological examinations, endoscopic;4) The established treatment whether medical, or surgical;5) The evolution and the postoperative consequences;6) The admission period. Prospective Phase: At the admission each patient to benefit: a complete interrogation, a complete physical examination, additional examinations including radio of the abdomen without preparation, the rate of hemoglobin and hematocrit, grouping/rhesus. Support: Our data were collected from medical records and operating records of patients in the department. Results: We collected 54 cases of sigmoid volvulus (the annual frequency was 13.5 cases for year), which accounted for 58.1% of colonic occlusions 19.6% of intestinal occlusions and 5.9% of operative operations in emergency. The average age was 47.13 with extremes of 18 and 102 years, The sex ratio is 4.40% in favor of men. Abdominal pain, vomiting, stopping of materials and gases were present in 32 (59.3%) patients. Von Wahl’s triad was present in 36 patients (66.7%), the rectal ampoule empty in 92.6%. On the X-ray of the abdomen without preparation, 70.37% of the image was recorded as a double leg. The sigmoid was necrotic in 37% of cases, and a sigmoid volvulus and necrotic hail in 7.4% of cases. We found a simple sigmoid volvulus in 61% of cases. We performed an immediate anastomosis resection in 63%, a Hartmann resection in 29.6%, an immediate anastomosis resection plus an ileostomy in 7.4%. Operative follow-up was simple in 85.2%, with a morbidity of 11.1%, and a mortality of 14.8%. Conclusion: Sigmoid volvulus is a serious surgical emergency requiring early diagnosis and management to improve prognosis. Pre-, postoperative and postoperative resuscitation associated with immediate anastomosis resection, or resection plus Hartmann, would reduce morbidity and mortality.展开更多
Sigmoid volvulus on pregnancy is a rare surgical emergency. We report two cases treated in the General Surgery Department of Sikasso Hospital between January 2009 and December 2017. The mean age was 34.8 years and the...Sigmoid volvulus on pregnancy is a rare surgical emergency. We report two cases treated in the General Surgery Department of Sikasso Hospital between January 2009 and December 2017. The mean age was 34.8 years and the gestational age ranged from 28 to 30 weeks. The evolution time was 4 days. The 2 patients were referred to us by gynecologist-obstetricians. They were operated after a short-term resuscitation. Inoperative the volvulus of the sigmoid was alone in 1 case;he was associated with a hail volvulus in the other. The volvated loop was necrotic in 1 case (small and sigmoid). A patient benefited from the Hartmann operation associated with a small bowel resection with end-to-end anastomosis. Simple sigmoidal detorsion was performed in one patient. We did not register a maternal death. The follow-up was simple in the 2 patients who gave birth vaginally.展开更多
Liposarcoma is a particular form of soft tissue sarcoma. First described by Virchow in 1860, liposarcoma is a rare mesenchymal tumor [1]. It represents 14% to 18% of all malignant tumors of the soft tissues and consti...Liposarcoma is a particular form of soft tissue sarcoma. First described by Virchow in 1860, liposarcoma is a rare mesenchymal tumor [1]. It represents 14% to 18% of all malignant tumors of the soft tissues and constitutes the most frequent soft tissue sarcoma [2]. For the majority of authors, it affects adult after the fourth decade. Because of the unusual age, we report a case of largeliposarcoma of the dorsal surface of the trunk. The appearance of the operative part made us think of a possible malignancy. A 35-year-old man without a notable patient history was admitted for a mass of the back discovered three years before without any notion of trauma. The patient affirms the recent appearance of an induration motivating the consultation. There were no associated signs such rectorrhagia, hematemesis, emaciation, pain. The physical examination finds a patient in good general condition. Locally, there is a swelling of the right lateral part of the 1/3 middle part of the back. It is an oval swelling of 25 cm long axis. Any fat tumor having a size more than 5 cm must therefore receive special attention even before the fourth decade.展开更多
文摘Objective: Analyze the maternal mortality in the two departments of CHU Point “G” in Bamako, because of high maternal mortality rate in our country. Material and Methods: This was an analytical cross-sectional study on maternal deaths from February 19, 2005 to November 19, 2019 for patients admitted in both departments and who died during the pregnancy-puerperal period at CHU Point “G”. All the patients who died outside this pregnancy-puerperal period were not retained. The data were entered and analyzed using SPSS 12.0 software. The statistical test used was that of Chi2, the statistical significance threshold was fixed at 5%. Results: During our study, we recorded 389 maternal deaths out of 16,033 admissions in 15 years and 18,060 live births during the same period making a maternal mortality ratio of 2153.931 and a frequency of 2.426. At the end of our study, we noted that the frequency of maternal deaths was higher in 2014: 12.9% (50/389). The maternal death predominantly affected women aged of 20 - 24 with a frequency of 22.4% (87/389). The multiparity (166/389 making 42.7%), illiteracy (341/389 making 87.7%), the poor evacuation conditions (non-medicalized transport): 263/389 making 67.6%;the evacuation without any evacuation sheet: 259/389 making 66.6%), poor CPN (Prenatal consultation) quality (undone CPN: 191/389 making 49.1%) and the poor monitoring of delivery works (no use of partograph in 343/389 making 88.2%) were the factors favoring maternal deaths. The main causes of maternal deaths were direct in 231/389 making 59.4% with hemorrhage in first line: 21.1% (82/389), infection (61/389 cases making 15.68%), dystocia: 50 cases making 12.85% and high blood pressure and complications (38/389 making 9.76%);indirect in 158/389 cases making 40.6% (Figures 1-3). The majority of women 65.8% (256/389) of our patients died in the gynecology and obstetrics department;in the Resuscitation department 73/389 making 18.8%;in the operating room 43/389 making 11.1% and the deaths that were observed on arrivals represented 17/389 making 4.4%. In our study, 10.3% (40/389) of our patients died in the antepartum, 57.1% (222/389) in perpartum, and 32.6% (127/389) in the postpartum (Figure 4). The need not covered in blood transfusion represented 91.5% the cases either 356/389. Conclusion: The frequency of maternal deaths is very high in our country. Reducing the rate of maternal deaths requires improving the SONU (cares obstetrical and neonatal emergency).
文摘The sigmoid volvulus is an acute strangulation of the colon by the twisting of the sigmoid loop around its mesenteric axis resulting in partial or complete obstruction of the colonic lumen. It is the most common intestinal volvulus and is an absolute medical and surgical emergency. Objectives: Determine the frequency of sigmoid colon volvulus, describe clinical and para-clinical signs, describe treatment, and determine morbidity and mortality. Methodology: This was a retrospective and prospective study performed in the General Surgery Department of Sikasso. This study concerned patients admitted and operated for sigmoid volvulus from January 1, 2014 to December 31, 2017. Retrospective Phase: We have created survey cards to study the following parameters: 1) The age and the sex;2) The clinical signs and associated defects;3) The radiological examinations, endoscopic;4) The established treatment whether medical, or surgical;5) The evolution and the postoperative consequences;6) The admission period. Prospective Phase: At the admission each patient to benefit: a complete interrogation, a complete physical examination, additional examinations including radio of the abdomen without preparation, the rate of hemoglobin and hematocrit, grouping/rhesus. Support: Our data were collected from medical records and operating records of patients in the department. Results: We collected 54 cases of sigmoid volvulus (the annual frequency was 13.5 cases for year), which accounted for 58.1% of colonic occlusions 19.6% of intestinal occlusions and 5.9% of operative operations in emergency. The average age was 47.13 with extremes of 18 and 102 years, The sex ratio is 4.40% in favor of men. Abdominal pain, vomiting, stopping of materials and gases were present in 32 (59.3%) patients. Von Wahl’s triad was present in 36 patients (66.7%), the rectal ampoule empty in 92.6%. On the X-ray of the abdomen without preparation, 70.37% of the image was recorded as a double leg. The sigmoid was necrotic in 37% of cases, and a sigmoid volvulus and necrotic hail in 7.4% of cases. We found a simple sigmoid volvulus in 61% of cases. We performed an immediate anastomosis resection in 63%, a Hartmann resection in 29.6%, an immediate anastomosis resection plus an ileostomy in 7.4%. Operative follow-up was simple in 85.2%, with a morbidity of 11.1%, and a mortality of 14.8%. Conclusion: Sigmoid volvulus is a serious surgical emergency requiring early diagnosis and management to improve prognosis. Pre-, postoperative and postoperative resuscitation associated with immediate anastomosis resection, or resection plus Hartmann, would reduce morbidity and mortality.
文摘Sigmoid volvulus on pregnancy is a rare surgical emergency. We report two cases treated in the General Surgery Department of Sikasso Hospital between January 2009 and December 2017. The mean age was 34.8 years and the gestational age ranged from 28 to 30 weeks. The evolution time was 4 days. The 2 patients were referred to us by gynecologist-obstetricians. They were operated after a short-term resuscitation. Inoperative the volvulus of the sigmoid was alone in 1 case;he was associated with a hail volvulus in the other. The volvated loop was necrotic in 1 case (small and sigmoid). A patient benefited from the Hartmann operation associated with a small bowel resection with end-to-end anastomosis. Simple sigmoidal detorsion was performed in one patient. We did not register a maternal death. The follow-up was simple in the 2 patients who gave birth vaginally.
文摘Liposarcoma is a particular form of soft tissue sarcoma. First described by Virchow in 1860, liposarcoma is a rare mesenchymal tumor [1]. It represents 14% to 18% of all malignant tumors of the soft tissues and constitutes the most frequent soft tissue sarcoma [2]. For the majority of authors, it affects adult after the fourth decade. Because of the unusual age, we report a case of largeliposarcoma of the dorsal surface of the trunk. The appearance of the operative part made us think of a possible malignancy. A 35-year-old man without a notable patient history was admitted for a mass of the back discovered three years before without any notion of trauma. The patient affirms the recent appearance of an induration motivating the consultation. There were no associated signs such rectorrhagia, hematemesis, emaciation, pain. The physical examination finds a patient in good general condition. Locally, there is a swelling of the right lateral part of the 1/3 middle part of the back. It is an oval swelling of 25 cm long axis. Any fat tumor having a size more than 5 cm must therefore receive special attention even before the fourth decade.
