Est-il possible de faire un diagnostic positif du syndrome de l’intestin irritable ?

The diagnosis of irritable bowel syndrome (IBS) is a clinical diagnosis, based on Rome III criteria. The identification of alarm signs, red flags, associated with an organic digestive disease is a key-point during the initial screening. Age higher than fifty, blood in faeces and diarrhoea seem to be the 3 most specific red flags. Biological and morphological examinations must be performed cautiously, their profitability is weak in patients having Rome criteria. In the majority of clinical situations during daily clinical practice, a positive diagnosis of IBS can be performed.     

Les tumeurs glomiques de l’orteil : à propos d’un cas de tumeur glomique de l’hallux

The Masson glomus tumour is a benign neuromyoarterial growth. Such tumours are rare and are most commonly described in the hand, however there are very rare cases of them in the foot. Tumours are characterised by a triad of clinical symptoms involving pain, tenderness and hypersensitivity. Diagnosis is often late. Although they are benign tumours, an early diagnosis is better as they can have an effect on quality of life. Diagnosis is made based on the clinical presentation, with an MRI scan being an additional optional investigation. These tumours do not respond to classic analgesics, therefore treatment involves their surgical excision. Histological analysis is used to confirm diagnosis. Reoccurrence is rare, but may occur; the patient should therefore be informed of this possibility.     

Importance de l’évaluation et du traitement des traumatismes de l’articulation de Lisfranc

There are several levels of severity with regard to tarsometatarsal joint (the Lisfranc joint complex) injuries. A careful assessment of the extent of the injury, the age of the patient and an objective examination of the damage enables the best treatment to be selected, whether it is orthopaedic or surgical, for a quick and full recovery. Our case mix means that the different therapeutic approaches for these injuries can be studied and it shows that the slow recovery can become debilitating in the long term, especially after several years of treatment. These injuries can be accompanied by damage to the forefoot (metatarsal pain, clinodactyly and metatarsal dislocation) that originates from an unidentified or inappropriately treated injury to the Lisfranc joint. Percutaneous treatment is not a definitive solution as it often leads to progression of a pain syndrome to the area over time.     

Contribution à l’étude de la mortalité dans un service d’urologie: Le cas du service d’urologie du CHU de Cocody d’Abidjan de 2000 à 2006

Objective

To analyze the incidence and main causes of mortality in the Department of Urology of the University Hospital of Cocody.

Patients and Methods

This retrospective analysis included 117 patients who died in the Department of Urology of the University Hospital of Cocody between April 2000 and December. Based on the data collected from the patient files, the hospital registry and the death certificates we studied the frequency and causes of death.

Results

The overall mortality rate was 10.1% with a male-to-female sex ratio of 14:1. The patients’ mean age was 63.4 (range 18–94) years. The main cause of death was cancer (87.5%). Cancer of the prostate which was the second most frequent reason for consultation after benign prostatic hyperplasia was the commonest cause of death encountered in 62.4% of the patients, followed by bladder and renal cancer with 16,2% and 6%, respectively. Prostatic adenoma (52%) was the most frequent and urethral stricture (8%) the third most frequent reason for hospitalization and led to death in 3.4% and 4.3%, respectively. Moreover, death mainly occurred in the second half of the month (53.9%) and during the night (57.3%).

Conclusion

The incidence of mortality in urology remains high and is almost exclusively related to urological cancers.     

Quand l’un reçoit l’autre. La reconstruction de l’intimité conjugale au sein d’un centre de rééducation

The stay in center of rehabilitation, following the arrival of a motor disability, is a period of important changes for the individual and his marital intimacy. He must now compose with new spaces, others and living conditions imposed by the center. This article analyzes the role of these elements on the reconstruction of a marital intimacy, at the time of the visits of the partner, while showing that if there are external constraints for the individual, this one is not passive in the reconstruction of such an intimacy, which can take several forms.     

Comparaison des effets de l’aprotinine et de l’acide tranexamique sur le saignement en chirurgie cardiaque

ObjectivesTo compare the efficacy of aprotinin (APR) and tranexamic acid (TRA) in reducing blood loss and transfusion requirements after cardiac surgery under extracorporeal circulation (ECC).Study designRandomized controlled trial.PatientsOne hundred and four adults undergoing either coronary artery bypass grafting (CABG) (n = 55), or aortic valve replacement (AVR) (n = 49), allocated into three groups.Methodsa) APR !roup (23 CABG and 20 AVR) recei· ved aprotinin, 2 × 10⁶ KIU (280 mg) after induction, followed by an infusion 0.5 × 106 KIU·h⁻¹ (70 mg·h⁻¹) until chest closure, with a supplement to the oxygenator prime of 2 × 10⁶ KW ; b) TRA group (22 CABG and 19 AVR) received tranexamic aeid, 15 mg·kg⁻¹ between the injection of heparin (400 IU·kg⁻¹) and the beginning of ECC, 15 mg·kg⁻¹ after protamin injection (1.3 mg/100 IU of heparin); c:) CTR group (10 CABG and 10 AVR), the control group, was not treated w1th an antifibrinolytic agent. The amount of blood collected from the chest tube drainage was measured at admission to ICU, as weil as 4, 8 and 18 h after the insertion of drains and at the time of their removal. Packed red cells where given when the haematocrit was under 20% during ECC, 25% at the end of surgery and 30% alter extubation.ResultsThe blood loss was lower in APR group (834 ± 448 mL) than in TRA group (1015 ± 409 mL) (P = 0.009), and in CTR group (1416 ± 559 ML) (P = 0.004). The rates of transfused patients in groups APR, ATR and CTR were 35,37 and 60% respectively and the numbers of units administered per patient were 0.8, 0.8 and 1.7 respectively. In AVR cases, APR and TRA had a similar efficacy. In CABG cases, only aprotinin decreased post-operative bleeding. However there was no difference between APR and TRA concerning the transfusion requirements. In CABG cases the ECC was of shorter duration and blood loss was 1127 ± 540 mL vs 894 ± 422 mL in AVR cases (P = 0.03).ConclusionsBoth APR and TRA decrease blood loss. APR is more efficient after CABG than TRA as far as blood loss is concerned, whereas the transfusion requirements are similar. As APR is about 100 times more expensive and carries a risk for allergie reactions, its use in a high dose regimen is only recommended for reoperations, in patients treated with salicylates and in case of sepsis.