Biomedical subjects
Publications and source records attributed to L Ribault.
The authors report their experience of the treatment of 81 cases of keloid scars in Africa. Many methods have been proposed and used but they do not consistently lead to good results. The fact that many operations have been indicates their back of efficacy. The natural tendency towards recurrence dictates the correct choice of operation. The best result is obtained by combining surgery with radiotherapy.
The author describes his experience after treatment of 8 cases of cubitus varus secondary to displaced supracondylar fractures of the humerus in African children. Measurement of the Baumann angle is necessary for the assessment of cubitus varus. The median angle is 24 degrees with a range of 10 degrees to 45 degrees. Indications were dictated by functional problems, discomfort, and esthetic considerations. The surgical treatment consisted in a supracondylar osteotomy of the humerus for correction of cubitus varus.
An experimental study on 15 piglets allowed defining the technical procedure and controlling the anatomical and functional results of various modes of restoration of the ileocolic tract after resection with a terminolateral tubing including and intracolic ileal sleeve. Coloileal fixation was ensured only by a few seromuscular sutures and adhesion with "Tissucol". The clinical application of this procedure was very satisfactory for 9 recent right colectomies, thus confirming the results previously observed for 33 ileal perforations in Africa. The ileocolic tubing technique is easy, reliable, morbidity-free, and causes no leakage of intestinal fluid, no intestinal ischemia and no stenosis. As it prevents coloileal reflux, this assembly may prevent ileitis after right colectomy. Its valvular effect also contributes in the mechanical regulation of transit. The assembly produces a system that can be compared to the ileocecal valve.
On the basis of a series of 17 cases in which GI continuity was restored by a containing esoduodenal intubation, the authors describe the technique, which consists in the approximation of the duodenum opposite the diaphragm. Esophageal intubation in the duodenum, the margins of which have been everted, allows preserving the physiological circuit, producing a new container within 3 months and ensuring an effective protection against reflux. The 17 patients had undergone total gastrectomy for advanced cancer, Gutman's stage II in 80% of all cases and stage III or more in the other 20%. 88% of the tumors were adenocarcinomas. There were no clinical or radiological signs of reflux, and no esophagitis was noted on repeated endoscopies. The postoperative mortality rate was 5.8%. The shortest time lapse is 1 year.
Author report 3 cases of total tibial pandiaphysis sequestration with total excision and secondary fibula bone grafting. Lenght, axis and strength of the leg were recovered when a built in fibula graft was realized.
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The author reports 9 cases of snake bite hand injuries in a regional hospital in the ivory coast. This study presents a number of particular points: patients often consult quite late; the precarious hygiene induces microbia contamination; patients often have a very poor conception of their body schema, which sometimes creates problems of understanding during reeducation. Treatment consists of emergency debridement under antibiotic cover of Iselin's "emergency with delayed surgery". The good blood supply of the hand allows satisfactory functional results.
The authors relate their experience with 8 cases of management of post-traumatic cubitus varus in the Africa child. In this series the mean varus angle, sense stricto, irrespective of the physiological valgus, was 24 degrees with extreme values ranging 10 degrees-45 degrees. Indication for surgery has always rested with the true varus value and with the degree of resulting esthetic and functional prejudice. Resection of an external bone wedge combined with synthesis using two crossed rods yielded good results, and rehabilitation was started as early as the first month after surgery.
On the basis of 10 cases (8 cases of rectosigmoid cancer and 2 of sigmoid volvulus), the authors report about their experience in the restoration of GI tract continuity using colorectal intubation into the rectal lumen and a transproctoanal anastomosis. This technique helps avoiding subperitoneal sutures, which are a cause of fistulae and shrinkage. It is simple enough to be performed by younger surgeons. This technique was initially developed for anterior resections for rectosigmoid cancer, and it can be utilized as an emergency procedure with single-piece resection without untwisting the sphacelous sigmoid loops, so that neither a temporary left iliostomy nor a second operation are needed.
Generalized peritonitis due to ileal perforation is common in Africa, and is caused by typhoid fever in most cases. For various reasons, the patients arrive at hospital in a poor general condition. In spite of combined intensive care and surgery, the general evolution of the disease resulted in a high mortality rate. All surgical techniques requiring sutures on a poor-quality ileon, ie. excision and suture, limited segmental resection or extensive ileal resection, most often lead to the breakdown of suture lines, so that the patient enters the vicious circle of repeated peritonitis and hazardous re-operations. Even exteriorized suture lines turn into fistulae, and temporary terminal ileostomy requires an amount of maintenance that is sometimes difficult to ensure in Africa. The technique proposed by the authors was developed in the department of surgery of the Dakar Main Hospital and has several advantages: It is a simple and quick procedure, which does not require the surgeon to be very experienced and can be performed in underequipped hospitals. There is no procedure-associated mortality. Morbidity decreases as the surgeon's experience increases. GI continuity can be established even in a septic environment. No second-look operation is necessary, so that the stay at hospital becomes shorter and the costs of treatment lower. Lastly, this type of restoration can be applied to other indications such as right colectomy and ileocolic or transverse ileal intubation.
Rupture of the uterus remains, in some countries, a frequent occurrence. This report of the obstetrical activity of a Regional Hospital Center in the Ivory Coast, demonstrates all the difficulties of a disconcerting pathology for visiting physicians, not used to this type of accident in Europe.
Vesico-vaginal fistulae (VVF) are still a daily occurrence in Africa. Obstetrical causes are the most frequent. This severe disability requires that everything be implemented to obtain a leak-free closure of the pathological opening. The authors report their experience with 89 cured cases of VVF. Except for 2 cases cured with an abdominal approach, the Moir technique gave good results in 78 cases, for midline, moderate size, fistulae. In 3 instances, closure of the vagina alone was satisfactory. There were 10 recurrences, cured 9 times at the second operation and once at the third. 3 recurrences came from other institutions and were cured after 4 and 5 successive procedures. In 6 instances, for fistulae close to 5 cm or larger and located in areas difficult to reach, the authors have developed a technique of vaginal closure alone using a turned-over, undetermined vaginal flap creating a leak-free diverticulum. No recurrences have been observed with this technique.
The authors have made an evaluation of the results obtained in orthopaedic surgery and traumatology after a four year practice at the Korhogo hospital (Cote d'Ivoire). They analyse the peculiar conditions bond to the pathology, climate, environment, technical level. The incidence of post operative sepsis was 2.8 per cent, comparable to european statistics. Bed sores were exceptional, the general rate of nonunions was 2.9 per cent. The functional results were hardly analysable. However they seemed to be rather satisfactory despite the lack of post operative rehabilitation. It is concluded that an orthopaedic and traumatologic practice can be valuably conducted in Africa even far from the main centers, provided a rigorous organisation.
From three cases of benign ovarian tumors in young African girls, the authors study the diagnostic means, among which ultrasonography is currently predominant. They finally discuss therapeutic means, with surgery permitting a histological diagnosis. Follicular cysts require a more nuanced approach; because of possible regression, one may consider repeated taps during laparoscopy, as surgery is not indicated just in the case of complications.
The authors describe their experience after treatment of 59 cases of volvulus of the pelvic colon. This disorder is frequent in West Africa and affects the protein deficient malnourished population. A definite predominance of volvulus occurred during the dry season between December and April, perhaps related to a diet richer in cellulose or deficient in water. There was a delay in presentation at the Hospital Center; necrosis of the twisted loop, the age of the patient and multiple associated conditions all contributed to the severity of this condition. Treatment had three aims: removal of the obstruction, reestablishment of continuity and avoidance of recurrence. Indications were dictated by the patient's general condition and the vascular status of the loop of bowel. It is reasonable to attempt reduction via intubation if the loop of bowel appears viable. Success enables a colectomy to be performed after a preparation, while failure necessitates surgical correction of ideally colectomy in a one stage procedure. On the other hand, a gangrenous loop necessitates colectomy without untwisting, with closure of the distal end using the Hartmann technique and with reestablishment of continuity 3 weeks later.
The rectal administration of irritant substances can induce lesions which do not regress after removal of the cause. More or less severe and more or less extensive stenoses have been reported in the literature. The authors report a case of very extensive and very tight rectosigmoid stenosis developing after potassium enema administered to a chronically constipated 26 year old African woman with limited rectal stenosis of unknown origin. Rectosigmoid and left colonic resection with trans-anal recto-colonic anastomosis gave this patient normal intestinal transit and good faecal comfort.
The authors described their African experience on the basis of ten cases of total rectal prolapse in the young adult and child. Total rectal prolapse and internal procidentia fall within the general context of disorders of rectal mechanics. In most instances, such forced prolapse occurs in young individuals who are usually muscular and used to difficult work. Nevertheless, defecation efforts in these chronically constipated patients play a significant role. Furthermore, there is frequently a concomitant presence of a megadolichosigmoid colon. In all cases treatment was surgical, involving rectopexy at the promontory using strips of fascia lata or even peritoneum. The post-operative course was in all cases uneventful with no recurrences and the routine prescription of adjuvant treatment for constipation.
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