A. Ndiaye

Posterior surgical approaches to the elbow: a simple method of comparison of the articular exposure

Purpose of the studyBilaterotricipital approach, triceps splitting and olecranon osteotomy are the three most common posterior approaches to the elbow. The aim of this study was to propose a simple technique to measure the exposure of distal articular surfaces of the humerus through these posterior surgical approaches.Materials and methodsEach approach was performed on ten cadaver elbows. After the completion of each approach, the visible articular surface was painted yellow. The elbow was then disarticulated. The unexposed articulated surface (by the approach) was painted blue. The painted surfaces were then wrapped using a net with meshes. The articular percentage of exposure was measured by calculating the mesh occupied by each painted surface.ResultsThe median exposed articular surface for the bilaterotricipital approach, the triceps splitting and the olecranon osteotomy was 26, 37 and 52%, respectively.ConclusionThe method is easy to perform and is reproducible.

Le nerf ischiatique à la fesse : Application à la « névrite » ischiatique post-injection

Resume L’injection intramusculaire est une pratique courante dans nos regions du fait de l’endemie palustre. Elle peut occasionner des accidents en particulier l’atteinte du nerf ischiatique a la fesse. Le but de notre travail est de determiner les bases anatomiques de la « nevrite » ischiatique post-injection. Vingt nerfs ischiatiques ont ete disseques a la region fessiere chez 10 cadavres frais adultes Africains melanodermes. Le nerf emergeait 18 fois du canal sub-piriforme et deux fois au-dessus chez un cadavre (bilateralite). Le trajet etait constant, avec une portion oblique et une portion verticale descendant dans la gouttiere ischio-trochanterienne. Le nerf croisait les muscles pelvi-trochanteriens sauf le piriforme. Par ailleurs, il etait croise entre ses deux portions par une arteriole venant de l’artere gluteale inferieure. Sa projection cutanee etait distante du quadrant supero-externe de la fesse. Une injection intramusculaire au niveau de ce quadrant evite l’atteinte directe du nerf. Les variations anatomiques du nerf etant quasi inexistantes, une autre hypothese causale de nevrite ischiatique post-injection devrait etre recherchee, en particulier la toxicite locale des sels de quinine. Leur diffusion dans l’espace sous cellulaire sous fessier (lieu de cheminement des vaisseaux et nerfs gluteaux) peut atteindre le nerf ischiatique vascularise par une branche de l’artere gluteale inferieure. Cette injection intramusculaire doit etre proscrite au profit de la voie intraveineuse ou de la voie intra-rectale chez l’enfant.

Artère temporale superficielle : Typologie et application au lambeau de fascia temporal superficialis

Resume L’objectif de notre travail est d’etudier la typologie de l’artere temporale superficielle (ATS) chez le sujet melanoderme selon la classification de Ricbourg et al. [8]. Pour realiser cette etude, nous avons dispose de 47 cadavres frais et de 3 tetes congelees. L’artere carotide externe (ACE), apres isolement au cou, a ete catheterisee et injectee de Rhodopas colore au rouge congo. L’ATS fut dissequee apres une incision cutanee en Y, dissection qui se terminait par la levee du lambeau de fascia superficialis temporalis. Seuls ont ete etudies le troisieme segment de l’ATS et ses branches terminales. Ce segment etait verticalement ascendant et contournait lateralement l’arcade zygomatique, se divisant en ses deux branches terminales temporo-frontale et temporo-parietale. La collaterale la plus importante, l’artere zygomato-malaire (AZM), est a la base de la classification de Ricbourg et al. [8] qui distingue deux types d’ATS :—_type I : l’AZM nait du tronc de l’ATS ; son trajet est perpendiculaire a celui-ci et legerement ascendant ; ce type I a ete retrouve dans 93 % des cas ;—type II : l’AZM prend son origine au niveau de la branche temporo-frontale avec un trajet horizontal ou obliquement descendant. Le type II a ete note dans 7 % des cas. Ces resultats, qui confirment ceux observes par Ricbourg et al.[8], ne nous permettent pas de mettre en evidence une quelconque incidence raciale pour la typologie de l’ATS dans notre contree. Nous n’avons pas etudie les dimensions de l’ATS de meme que le niveau de bifurcation de celle-ci car ils ont ete largement decrits dans la litterature. Ces elements, sans doute, constituent en grande partie les bases anatomiques de la chirurgie des lambeaux temporaux. La lame porte-vaisseaux dans laquelle chemine l’ATS constitue le fascia temporalis superficialis (FTS) dont la plasticite et la polyvalence constituent des atouts considerables en chirurgie plastique et reconstructive.

Anatomical variations in lymphatic drainage of the right lung: applications in lung cancer surgery

ObjectivesTo specify the topography and variations in lymphatic drainage of the right lung to the mediastinum and their therapeutic implications in non-small cell lung cancers (NSCLC).Materials and methodWe injected a dye into the subpleural lymphatic vessels in 65 right lung segments, followed by dissection in 22 subjects.ResultsAt the upper lobe, we had injected 32 segments. We noted extrasegmental overflow in one case; extrasegmental and extralobar drainage in two cases; drainage to the lymph nodes of another lobe in one case. Fifty-six percent of the segments drained directly (skipping intrapulmonary and hilar lymph nodes) into the right paratracheal lymph nodes, and one dorsal segment drained into the thoracic duct. A ventral segment drained into the inferior tracheobronchial lymph nodes. A contralateral drainage to the recurrent chain was observed in two cases. Sixteen segments of the middle lobe were injected and mainly drained into the inferior tracheobronchial lymph nodes with six direct paths; one medial segment drained into the right anterior mediastinal chain. We noted three contralateral drainages and eight downward abdominal drainages. Out of the 17 segments of the lower lobe injected, 6 segments drained into the lymph nodes of another lobe, 5 segments showed a direct route to the lower quadrant chains. We noted one time a drainage into the paraesophageal lymph nodes.ConclusionThe variations in lymphatic drainage of the right lung require to carry out systematically a radical mediastinal lymphadenectomy during the removal of non-small cell lung cancers and to associate an adjuvant treatment.

Variations in lung lymphatic drainage into the inferior tracheobronchial lymph nodes junction: Applications in lung cancer.

The group of inferior tracheobronchial lymph nodes (ITB) is a lymphatic junction through which the lymph from both lungs is carried. Lymphatic activity in this area can be used to assess the lymphatic spreading of lung cancers. Our aim was to quantify lymph drainage from the lung segments towards the ITB group and to determine the direction of the lymph flow into other mediastinal and abdominal lymph nodes. We injected dye directly into the subpleural lymphatic vessels in 100 lung segments of 25 fresh cadaver subjects; the cadavers were then dissected. Thirty‐eight segments (38%) drained into the ITB group in 18 subjects. The drainage into the ITB group involved 15.6% of the upper lobe segments, 87.5% of the middle lobe segments, and 70.6% of the lower lobe segments in the right lung. On the left, 6.9% of the upper lobe segments and 83.3% of the lower lobe segments were drained into the ITB group. For three subjects, the dye did not pass beyond the ITB group. The efferent vessels of the ITB group drained towards the right paratracheal and tracheoesophageal chains in 12 subjects and through the left ascending recurrent chain in five subjects. For six subjects, the efferent channels reached the abdominal lymph nodes. A contralateral drainage involved 14 segments (36%). The size and variety of the segments that drain into the ITB group, coupled with the efferent contralateral mediastinal and abdominal pathways, account for the severity of metastasis to this area. Clin. Anat. 29:955–962, 2016.

Radio-anatomie du côlon descendant dans l’espace pararénal gauche : à propos de 1084 sujets

AIMS Due to the severity of colonic injuries and their frequency on the left side, we study relationships between the left kidney and the descending colon to identify subjects at risk of colonic perforation during percutaneous surgery of the left kidney. MATERIAL AND METHODS Over a period of 3 years we exploited abdominal CT scans for 1084 patients in both sexes without any visceral or parietal lesions. We studied the situation and relationships of the lumbar part of the descending colon in the left pararenal space using a conventional grid technique. RESULTS The preferential site of the colon in both sexes was laterorenal in 55.8% of cases. We also found the descending colon in a posterolateral situation in 21.1% of cases, and in an anterolateral situation in 14.8% of cases. In women, the posterolateral situation was twice more common than in men, but we did not observe any post-renal situation. Laterorenal and posterolateral situations were the most frequent in patients less than 50 years; while beyond this age 70.1% of subjects had a laterorenal type. CONCLUSION Sex and age affect topographic variations of the lumbar part of the descending colon in the left pararenal space. Although they are rare or aberrant, some locations exist and should not be ignored by the operator. These locations are risk factors of colonic lesion during percutaneous approach of the left kidney.

Mitral Valve Replacement in Senegal (West Africa): Indication and Short-Term Outcomes

The West African countries have infrequent Cardiac Surgery Centers. Mitral valve replacement (MVR) from such countries raises important postoperative preoccupations. The aim of this study is to report indication and short-term outcomes of MVR at the Cardiac Surgery Center of the University Hospital in Dakar (Senegal). This is a retrospective analytical and descriptive study covering a period of 19 months (From January 2015 to July 2016). All patients with MVR associated or not with tricuspid valve repair were included in this study. Seventy-three (73) patients were eligible. The mean follow-up was 4.2 ± 4 months (range, 1-12). The mean age was 30.4 ± 13 years (range, 9–64). There were 74% of female patients, 53% were in New York Heart Association class III. Preoperative diagnoses were mitral stenosis (31.5%); mitral regurgitation (37%) and mixed mitral disease (31.5%). Crystalloid cardioplegia was performed in 92%, mean CPB time was 79 ± 21 min, mean cross clamp time was 58 ± 15.6 min. Mitral valve exposure was performed by left atriotomy (93%); 99% of mechanical prosthesis was performed. Tricuspid valve repair was performed concomitantly in 48% of patients. Overall Hospital mortality was 8%. Postoperative complications were low output syndrome (19%), pneumonia (12%), surgical wound infection (8%), Pleural effusion (7%). During follow-up, no valve-related morbidity and mortality was recorded. Mechanical valve replacement in Senegal has acceptable early outcomes in terms of morbi-mortality. Preoperative diagnoses were represented in equivalent proportions by mitral stenosis; mitral regurgitation and mixed mitral disease. Our complications were predominantly low output syndrome and pleura pulmonary disorders.

Diagnosis and indications for revascularization in Takayasu’s Arteritis: Report of two cases and literature review

Takayasu’s arteritis (TA) is an infl ammatory disease of large vessels that predominantly affects the aorta and its main branches such as supra-aortic trunks, renal and digestive arteries. The diagnosis is based on criteria proposed by the American College of Rheumatology and modifi ed by Sharma. These vascular lesions present a problem of surgical indications because of their pathogenic particularity. In this work, we report our experience on the diagnosis and management of two cases of TA.

Thoracoplasty in the Management of Chronic Empyema: Experience of a Sub Saharan African Country

Introduction: The current main indication of thoracoplasty is empyema following or not lung resection, when the other surgical methods such as thoracic drainage, pleurostomy and/or pulmonary decortication have failed or are not useful. The authors report the role of thoracoplasty in the management of chronic empyema. Method: Between 2004 and 2015, eight male patients underwent thoracoplasty, in the Department of Thoracic Surgery at the University Hospital of Fann, Dakar, Senegal. The mean age was 40 years old. In all cases, the first step of the treatment was thoracic drainage with Heimlich valve in an ambulatory patient, associated with antibiotic according to the result of bacterial culture. In three patients, thoracostomy was indicated to control local infection before thoracoplasty. Results: Indications for thoracoplasty were refractory post resectionnal lung empyema in 6 cases and chronic primary apical empyema in 2 cases. Bronchopleural fistula was found in 5 patients. We performed three superior partial thoracoplasty, and five enlarged thoracoplasty. A myoplasty, using latissimus dorsi to fill the empyema space, was associated with thoracoplasty in five cases. Bronchopleural fistula cure consisted of a direct X form suture in two cases and of intercostal muscle apposition on the fistula in others ones. Partial scapulectomy, by resection of the inferior third part of the scapula was done in three patients. After a mean follow up of one year, no patient presented with persistence or recurrence of empyema. Then we concluded that they were healed. Conclusion: Thoracoplasty is an efficient procedure for the management of chronic empyema. So it is necessary for each team to established define criteria that will allow a patient to undergo thoracoplasty in order to do not use it for any desperate case of refractory chronic empyema.

Penetrating chest injuries caused by swordfish sword used as a weapon

We report 5 cases of penetrating chest wounds caused by weapons made from swordfish swords, involving breakage of the sword that later appeared as a thoracic foreign body. The patients had been assaulted 2 days to 17 years earlier. Three of them had a chronic infected wound, one had a penetrating thoracic wound with hemopneumothorax, and one had a foreign body. Computed tomography showed a foreign body in the lung in 4 cases, with aortic penetration in one. The foreign body was removed via thoracotomy in all 4 patients, with aorta repair in one who presented later with a pseudoaneurysm.