[Implementation of hemovigilance in Sub-Saharan Africa]. / Mise en place de l'hémovigilance en Afrique subsaharienne.

PURPOSE OF THE STUDY: Hemovigilance being an essential part of blood transfusion safety, many countries have set legislation for its organization and its establishment. In Sub-Saharan Africa, where transfusion practice is facing many challenges, hemovigilance does not always appear as a priority. Nevertheless, in 2000, Burkina Faso decided to reorganize its blood transfusion system according to the World Health Organisation recommendations and other international standards. A national blood transfusion center and regional blood transfusion centers were created. From 2005 to 2009, a hemovigilance pilot project was conducted by the regional blood transfusion center of Bobo-Dioulasso. METHODS: The implementation of this hemovigilance project included the following steps: training of medical and paramedical personnel of the health facilities provided with blood and blood products by the regional blood transfusion center, distribution of post transfusion and hemovigilance forms, and the creation of a hemovigilance and transfusion committee. RESULTS: During the period 2005-2009, 34,729 blood products were distributed for 23,478 patients. The return rate of the post-transfusion and hemovigilance forms (number of files completed partially or completely and returned to the regional blood transfusion center compared to the number of units distributed) raised from 83.1 to 94.8%, the rate of traceability (rate of forms returned to the regional blood transfusion center and totally completed) raised from 71.6 to 91.6%, and the concordance between the patient for which the blood was delivered and the patient transfused moved from 92.9 to 98.0%. The notification rate of transfusion incidents raised from 1.1 to 16.1 per 1000 units transfused during that period. CONCLUSION: The implementation of a hemovigilance system is possible in the Sub-Sahara African countries. This constitutes a major element in the improvement of different steps of transfusion safety. The implementation of a hemovigilance system requires negotiations between transfusion centers and the hospital personnel, and should be facilitated by the official regulation on blood transfusion practices.

[Surgery of congenital malformations in developing countries: experience in 13 humanitarian missions during 9 years]. / Chirurgia delle Malformazioni Congenite nei paesi in via di sviluppo: esperienze maturate nel corso di 13 missioni umanitarie in 9 anni.

The authors report their surgical experience concerning seriously impaired children due to congenital malformations or other non-congenital anomalies such as burns and traumas. All the patients were operated in one of 13 humanitarian missions undertaken in four developing countries. Throughout the "Third World" the demand for reconstructive surgery is extremely high due to the high birth rate and consequently large number of patients, as well as the shortage of both medical staff and supplies. In developing countries Primary Health Care has always been considered a priority and so hospitals, which are used mainly for emergency operations, are usually few in number and badly equipped; elective surgery is considered a luxury. Children with congenital diseases and/or other non-congenital anomalies who are fortunate enough to reach a hospital will often be treated by general surgeons lacking specific training; those children suffering from disabling conditions are often neglected and left to live with their anomalies for the rest of their lives. Our surgical missions have always been undertaken at the request of Catholic missionaries and/or secular organizations which contribute to the individual health schemes of each country. Highly experienced volunteer staff took part in the missions; medical teams are made up of 2 surgeons, one or two anaesthetists and two scrub nurses. The assistance and cooperation of local medical staff was essential in the preselection of cases to be operated while each single medical team provided all the necessary supplies for surgery, which took place in small but well-equipped missionary hospitals provided by the local authorities. A total of 1140 children were operated on during the 13 missions: 32% of these had routine procedures performed in day surgery and 54% underwent major plastic and reconstructive surgery for facial, uro-genital and anorectal malformations or for serious consequences of burns or traumas. The proportion of emergencies was only 3% as these were normally excluded because of the short duration of the missions. 26 patients had to be reoperated as a result of complications or surgical failure and long-term follow-up provided by either the local staff or as a part of later missions was given in over 70% of the major surgery performed. On the whole, the surgical results were highly satisfactory even if a final evaluation should be made taking the cultural factors and the socio-environmental conditions of each individual country into consideration. Such an evaluation should most importantly be made on the basis of the well-being of the patient, general satisfaction of the families involved and improved quality of life of these children.

[The incidence of gastric carcinoma after gastrectomy for peptic ulcer in the Vigo region. A case-control study]. / Frecuencia del carcinoma gástrico postgastrectomía para úlcera péptica en la comarca de Vigo. Estudio caso-control.

After reviewing 10,000 upper gastrointestinal endoscopies performed at the endoscopy unit of the city of Vigo over a 38 month period, we have found 485 partial gastric resections for peptic ulcer, 357 gastric carcinomas were found, of which 26 occurred after partial gastric resection for peptic ulcer. Therefore the incidence of gastric cancer in this area was 22-23/100,000. The frequency of gastric cancer after partial resective surgery was lower than expected during the first 20 years after surgery. However, thereafter a significant increase of gastric cancer occurred in those patients in which a Billroth-II but not Billroth-I procedure was used.

[Choledocholithiasis in non-cholecystectomized patients: endoscopic sphincterotomy and afterwards ... cholecystectomy?]. / Coledocolitiasis en pacientes no colecistectomizados: esfinterotomía endoscópica y después...colecistectomía?

Choledocholithiasis in patients with a gallbladder "in situ" is presently one of the most frequent indications of endoscopic sphincterotomy. The crucial problem of these patients is whether or not they require eventual cholecystectomy to avoid the risks of potential complications of cholelithiasis. Of the 39 patients (mean age 80.1 +/- 8.2 years) with choledocholithiasis and gallbladder "in situ" released from this hospital from October 1979 to December 1985 after a successful endoscopic sphincterotomy (expulsion, spontaneous or not, of gallstones), 33 (84.6%) have been followed-up for an average of 41.5 +/- 20.8 months (7-92 range). During this time only one patient (3%) developed acute cholecystitis that required cholecystectomy, and two (6%) denoted mild pains in the right upper quadrant, while the other 30 (91%) remained asymptomatic. Over these years 10 patients (30.3%) died from nonbiliary causes. In conclusion, in elderly or high surgical risk patients who present choledocholithiasis and gallbladder "in situ", endoscopic sphincterotomy is effective. Later cholecystectomy to prevent the complications of cholelithiasis would not be justified as a routine measure in most of these patients.

[Mesenteric venous thrombosis: a new case of favorable course using conservative treatment]. / Trombosis venosa mesentérica: un nuevo caso de evolución favorable con tratamiento conservador.

Mesenteric venous thrombosis (TVM) is an uncommon entity with a mortality without surgical treatment of virtually 100%. However, recently some cases have been reported of a good evolution with conservative treatment. We present a patient with mesenteric venous thrombosis diagnosed by arteriography who, after refusing surgical intervention, underwent parenteral nutrition and anticoagulant treatment. This case constitutes another proof that mesenteric venous thrombosis is not invariably fatal without surgical treatment.