ABSTRACT
BACKGROUND: Reliable data on severe head injury mortality is rarely reported in Sub-Saharan African countries and in Cameroon in particular. It was for this reason that for the first time ever a prospective study was carried out during a one year period in the university hospitals and some selected regional and district hospitals in Cameroon. MATERIALS AND METHODS: All the patients admitted for head injury in the emergency units of the selected hospitals were enrolled and followed up over a period of one month. RESULTS: A total of 2835 consecutive patients were included with a sex ratio M/F=3.7/1. One hundred and seventy nine (179) patients lost to follow up were not included. The mortality rate was 77% in the severe head injury group, 16% in the moderate head injury group and 1% in the mild head injury group. In the group of severely injured patients, the mortality rates were very high in the academic hospitals (Laquintinie Hospital of Douala, General Hospital of Douala, Yaounde Central Hospital, and Yaounde University Hospital; 83%, 83%, 81%, and 73% respectively) and in the Regional Hospital of Garoua (84%). CONCLUSION: Mortality rates associated with head injury remain very high in Cameroon, and this is likely true in many countries across Sub-Saharan Africa. The figures approach the mortality expected in the natural history of the disease. Strategic plans should be taken at the local and national levels as in the case of maternal mortality and HIV infections.
Subject(s)
Craniocerebral Trauma/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Blood Pressure , Cameroon/epidemiology , Child , Craniocerebral Trauma/diagnostic imaging , Craniocerebral Trauma/etiology , Craniocerebral Trauma/therapy , Female , Follow-Up Studies , Glasgow Coma Scale , Hospitals, Teaching , Hospitals, University , Humans , Male , Middle Aged , Prospective Studies , Risk Factors , Tomography, X-Ray Computed , Young AdultABSTRACT
INTRODUCTION: Intracranial suppurations (ICS) are collections of pus of infectious origin in the skull. The authors present their experience. PATIENTS AND METHOD: All children operated for ICS at the Central Hospital of Yaoundé from January 2000 to December 2008 were retrospectively included. RESULTS: Thirty-five patients were recruited: 26 (74.29 %) males and 9 (25.71 %) females. These represent 82.9 % of all ICS operated in our institution. ICS represented 14.3 % of intracranial space-occupying lesions. The mean age was 8.34 years. They presented with headaches (80.77 %), altered consciousness (20 %), convulsions (76 %), vomiting (20 %), unilateral motor deficit (69.23 %), speech disorders (12 %), and fever (89.29 %). Bergman's triad (51.86 %) was frequent. The primary infection was: meningitis, eight cases (22.85 %); sinusitis, six cases (17.14 %); head trauma, five cases (14.28 %); otitis media, one case (2.85 %); suppurations of the face, three cases (8.56 %); cardiopathy, one case (2.85 %); and craniotomy, one case (2.85 %). In seven cases (20 %), the origin was unknown. The lesions were empyema in 23 cases (65.71 %), cerebral abscess in 8 cases (22.85 %) and pyoventriculitis in 2 cases (5.72 %). The surgical procedures were burr holes (88.89 % of empyemas) and trepano-puncture-aspiration (75 % of abscesses). The mortality (21.42 %) and morbidity (42.85 %) were recorded. CONCLUSION: ICS are frequent but preventable (early treatment of the primary infection) pathologies of childhood in developing countries. Burr hole drainage (empyemas) and puncture-aspiration (abscesses) are simple, safe, and effective techniques.
Subject(s)
Brain Abscess/etiology , Brain Abscess/prevention & control , Empyema/etiology , Empyema/prevention & control , Neurosurgical Procedures/adverse effects , Adolescent , Africa/epidemiology , Brain Abscess/diagnostic imaging , Brain Abscess/epidemiology , Child , Child, Preschool , Empyema/diagnostic imaging , Empyema/epidemiology , Female , Humans , Infant , Infant, Newborn , Longitudinal Studies , Male , Retrospective Studies , Severity of Illness Index , Suppuration/epidemiology , Suppuration/prevention & control , Tomography, X-Ray ComputedABSTRACT
OBJECTIF: L'objectif était d'évaluer la faisabilité, les indications et les complications de la rachianesthésie en chirurgie pédiatrique à l'Hôpital Central de Yaoundé. MÉTHODOLOGIE : Il s'agissait d'une étude descriptive, prospective s'étalant sur 12 mois d'octobre 2009 à septembre 2010 à l'Hôpital Central de Yaoundé. Etaient inclus tous les patients de 1 jour à 16 ans devant subir une chirurgie sous ombilicale sous rachianesthésie. RÉSULTATS : Cinquante cinq patients âgés de un jour à 16 ans ont été colligés dont 38 garçons (69,09)% et 17 filles (30,9%), soit un sex ratio de 2,23. Il y avait 81.8% de patients ASA1 et 18,2% de patients ASA2. 34,54% avaient entre 0 et 5 ans ; 21,81% entre 5 et 10 ans, et 46,35% au-dessus de 10 ans. 81,8% des chirurgies étaient programmées et 18,2% étaient en urgence. La rachianesthésie a été réalisée par les infirmiers anesthésistes dans 14,55% des cas. Dans 58,19% des cas, le niveau de ponction se situait entre L4 et L5.Les aiguilles G22 ont été utilisées dans 89,09% des cas. Les chirurgies les plus fréquentes étaient viscérales (49,1%), traumatologiques (36,36%) et urologiques (14,54%). Les indications les plus fréquentes étaient la cure d'hydrocèle, la hernie inguinoscrotale (48,15%) et l'ostéosynthèse du fémur (35%). La durée moyenne de toutes les interventions était de 63,76 ±19,39 minutes, la plus longue ayant duré jusqu'à 130 minutes. Aucune complication n'a été enregistrée. CONCLUSION : La rachianesthésie est de plus en plus utilisée dans la pratique en anesthésiologie pédiatrique à Yaoundé. Ses indications couvrent en général les chirurgies abdominales sous-ombilicales et des membres inférieurs. Elle procure une anesthésie pouvant durer jusqu'à 130 mn. Elle est fiable, facile, sûre et semble n'avoir aucun effet secondaire
Subject(s)
Anesthesia, Spinal , Anesthesia, Spinal/adverse effects , Cameroon , Pediatrics , Surgical Procedures, OperativeSubject(s)
Adjuvants, Anesthesia/administration & dosage , Anesthesia, Spinal , Anesthetics, Dissociative/administration & dosage , Anesthetics, Local/administration & dosage , Bupivacaine/administration & dosage , Fentanyl/administration & dosage , Ketamine/administration & dosage , Adolescent , Adult , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
OBJECTIVE: To assess acute abdomens incidence of parasitic origin at Yaounde (Cameroon) and evaluate their different management modalities. MATERIALS AND METHODS: Retrospective study from January 1973 to December 2002 of patients managed at Department of Surgery, Central Hospital, Yaounde (Cameroon). RESULTS: Among 3464 acute abdomens managed by laparotomy during this period, 135 patients (3.9%) had a parasitic origin. Ninety-seven patients (79%) were operated on before 1990. Among these 135 patients, 63 (47%) had peritonitis secondary to liver amoebic abscess intraperitoneal rupture, 24 (18%) had acute intestinal obstruction due to an ascaridioma, 21 (15%) had appendicitis of parasitic origin, 15 (11%) had amoebic typhlitis, 4 (3%) had pancreatitis and/or angiocholitis caused by the obstruction of ampulla of Vater by an adult ascaris worm, 4 (3%) had intestinal perforation by ascaris, and 4 (3%) had intussusception (tricocephalus). CONCLUSIONS: Incidence of abdominal emergencies of parasitic origin is unfrequent but not rare at Central Hospital, Yaounde, Cameroon. This incidence is decreasing over time. However, liver amoebic abscess intraperitoneal rupture is the most common cause of peritonitis and is still associated with postoperative high mortality rate. Preoperative diagnosis could lead to non-operative management that may be associated with better prognosis.
