Characteristics of patients and patterns of chronic venous disease of the lower limbs in a referral hospital in Cameroon.

OBJECTIVE: The objective of this study was to investigate the magnitude of chronic venous disease (CVD) in sub-Saharan Africa, specifically the characteristics of the patients, the symptoms, the signs, and the severity. METHODS: From December 2013 to December 2016, a cross-sectional study was conducted of all consecutive patients with CVD aged ≥18 years and attending the outpatient clinic of the Yaoundé General Hospital in Cameroon. We recorded information on demographics, relevant medical history, symptoms, lifestyle, and clinical presentation. A duplex ultrasound examination investigated veins to seek obstruction and reflux (duration ≥0.5 second). The full Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification was used to describe CVD, and severity was assessed by the Venous Clinical Severity Score (VCSS). Statistical significance was at P < .05. RESULTS: Altogether, 319 patients (503 affected legs) were enrolled; 54.3% of patients were men with a mean age of 44.5 years (18-85 years) and CVD duration of 3 months to 45 years (mean, 2.3 years). Patients had such risk factors as obesity (32.6%), family history of CVD (17.7%), multiparity, and lifestyle requiring long standing periods (64.8%). Only 15% of women older than 49 years were using birth control pills, and none older than 49 years were receiving hormone replacement therapy. Only 42.9% of patients had previously been treated for CVD, mainly with venoactive drugs (34.1%). Of the 503 legs, 366 (72.76%) were symptomatic in the following proportion: leg heaviness, 236 (64.48%); sensation of swelling, 236 (64.48%); pain, 194 (53%); sensation of "pins and needles," 87 (23.77%); night cramps, 89 (24.39%); and itching, 66 (18.03%). Men had more symptoms (P = .027). The mean total VCSS was 4.62 ± 4.15 (range, 1-21). The most frequent VCSSs were 0, 2, 3, and 4, and the components of the VCSS most frequently represented were pain, varicose veins, and edema.Patients were assigned to CEAP classes as follows. The C class included C0, 6.1%; C1, 35.4%; C2, 39.6%; C3, 42.7%; C4a, 11.9%; C4b, 4.9%; C5, 1.5%; and C6, 10.13%. The E class designated etiology as primary in 446 (88.66%), secondary in 49 (9.7%), and congenital in 8 (1.59%). The A class identified superficial veins in 365 (72.56%), deep veins in 218 (43.33%), and perforator veins in 22 (4.37%); no venous location was identified in 31 (6.16%). According to the P classification, of the 466 legs of level II and III CEAP, 289 (62%) had reflux, 43 (9.2%) had obstruction, 22 (4.6%) had both reflux and obstruction, and 113 (24.3%) had no venous disease identifiable, with no sex influence on the frequency of reflux (P = .27) but a higher proportion of obstruction in men (P = .00029). CONCLUSIONS: Patients have many risk factors and are young with a male predominance. Most patients are symptomatic with advanced disease. The etiology is primary in most patients, and reflux is more common.

Indications and morbidity of tube thoracostomy performed for traumatic and non-traumatic free pleural effusions in a low-income setting.

INTRODUCTION: Tube thoracostomy (TT) is widely used to resolve a number of pleural conditions. Few data are available on the complications of TT performed for non-traumatic conditions, especially in low income setting. The aim of this study is to analyse the indications and complications of TT performed for both traumatic and non-traumatic conditions of the chest in a low-income environment. METHODS: This retrospective study conducted over a four years period in a the Regional Hospital, Limbe in South-West Cameroon analyses the rate and nature of complications after TT performed for both traumatic and non-traumatic conditions. Different factors related to complications are analysed. RESULTS: We analysed 134 patients who had 186 chest tubes inserted. After placement, tubes were either connected to a water seal system (40%) or submitted to suction (60%). Most (91%) procedures were performed for a non-traumatic condition. Non-infectious pleural effusion in patients with HIV infection or pulmonary tuberculosis was the most common indication. Sixty six per-cents of procedures were carried out by a general surgeon. The complication rate was 19.35%. The most common complications included tube dislocation and pneumothorax. Most complications were solved by replacement of the tube. The nature of operator (general surgeon vs general practitioner) was a significant predictor of outcome (p < 0.01). No procedure related death was recorded. CONCLUSION: TT is a safe and efficient procedure to drain pleural collections of both traumatic and non-traumatic origins, even in low-income settings. The incidence of complications could be reduced by a better training of general practitioners on this procedure.

Strangulated or incarcerated spontaneous lumbar hernia as exceptional cause of intestinal obstruction: case report and review of the literature.

Lumbar hernias are rare conditions and about 300 cases have been reported since the first description by Barbette in 1672. Therefore strangulation or incarceration are also exceptionally encountered. We present a 62 -year-old-man who had strangulated left lumbar hernia and consequent mechanical small-bowel obstruction, alongside with a non strangulated right lumbar hernia. Through a median laparotomy, an intestinal necrosis was found. A bowel resection with end to end anastomosis was performed and the lumbar hernias were repaired on both sides. The recovery was uneventfull. To the best of our knowlwdge thanks to the litterature review presented here, this is the 19th case of incarcerated or strangulated spontaneous lumbar hernia described in the surgical litterature since 1889.

Epidemiology of paediatric injury in low income environment: value of hospital based data prior to the institution of a formal registration system.

BACKGROUND: Little attention is generally paid to paediatric injuries, especially in low income settings. The aim of this study is to provide an overview of the epidemiology of hospital-based paediatric injuries in a semi-urban area in Cameroon prior to the initiation of a formal registration system. PATIENTS AND METHODS: A sixteen items data collection sheet derived from a newly instituted trauma registry is used to retrospectively gather hospital-based basic information about epidemiology of injuries in patients aged 15 years or below in a low income setting. RESULTS: Two hundred and seventy seven cases representing 16% of all injury cases could be analysed. The frequency of injuries significantly increased with age with a peak between 11 and 15 years (P < 0.001). Children in school playgrounds carried a significantly higher risk of sustaining an injury (P < 0.001). Falls and interpersonal violence were the most frequent mechanisms. The face and locomotor systems were the most commonly involved. More than 60% of patients were discharged back home. CONCLUSIONS: The data from the present registration system seem to indicate a higher injury rate in pre-adolescent children and in the school playground. The institution of a formal registration system is likely to improve the quality of data recording system.

Successful management of pregnancy in an African woman with Klippel Trenaunay syndrome.

Klippel Trenaunay syndrome (KTS) is a rare congenital disease characterized by a triad of cutaneous hemangioma, varicose veins and bone or soft tissue hypertrophy. Cases of pregnancy complicated by KTS are rare. There is an increased risk of thrombo-embolic disease and hemorrhage during pregnancy. Both obstetric and anesthetic management of KTS in pregnancy can be rather complicated. We present a successful management of pregnancy in an African woman with KTS at Yaounde General Hospital, Cameroon.

Complications of arteriovenous fistula for hemodialysis: an 8-year study.

BACKGROUND: To assess the frequency and characteristics of complications of arteriovenous fistula (AVF) and their effect on fistula outcome. METHODS: We retrospectively reviewed 628 AVFs constructed from November 2002 to October 2010 to record the complications and their management options. The association between age, sex, comorbidities (HIV, hypertension, and diabetes), fistula type, and complications was sought. RESULTS: Most patients were males (73.7%). The mean age was 45.3 years. Comorbidities seen included diabetes mellitus (22.12%), hypertension (83.12%), and HIV infection (9.87%). AVFs constructed were mainly radiocephalic (68%) and brachiocephalic (24.9%). The median follow-up period was 275 days. The cumulative patency rate was 76% and 51% at 1 year and 2 years, respectively. Altogether, 211 complications occurred in 16% of the AVFs. Among them, 36.96% were severe, 25.11% moderate, and 43.91% minor. With respect to the time of occurrence, 63.98% were late complications, 12.79% immediate, and 23.22% early. Aneurysms, failure to mature, and thrombosis were the most frequent complications occurring in 26.54%, 14.69%, and 12.79% of cases, respectively. The management options for the complications included the creation of a new access in 36.96%, a temporary catheter before a new AVF in 10.52%, and nonoperative management in 43.12%. We found no adverse effect of comorbid factors such as diabetes mellitus (χ(2) = 3.58, P > 0.05) or HIV-positive status (χ(2) = 0.64, P > 0.05) on the complication rate. CONCLUSION: This study shows an overall frequency of complications of 16%. These results show the potential for low complication rate of AVF in selected population.

Patients characteristics and outcome of 518 arteriovenous fistulas for hemodialysis in a sub-Saharan African setting.

BACKGROUND: To present the particular aspects of arteriovenous fistula (AVF) for hemodialysis in sub-Saharan Africa in terms of patients' characteristics, patency and complication rates, as well as factors influencing them. METHODS: From November 2002 to November 2009, 518 fistulas were constructed on adults. Demographic data, patency, and complications were analyzed. The association between age, sex, and comorbidities (HIV, hypertension, diabetes) on one hand and complications as well as AVF patency on the other was sought. RESULTS: Males represented 73.7% of the patient population, and the mean age of the population was 45.3 years. As far as etiologies of end-stage renal disease (ESRD) and comorbidities are concerned, chronic glomerulonephritis was the leading cause of ESRD (134; 25.9%), followed by hypertension (22.3%), although prevalent in 83.2% of patients, and diabetes (20.1%), although prevalent in 22.2%. No cause for the ESRD could be identified in 89 patients (17.2%). Only 20.64% had AVF as the initial vascular access. The main types of AVF constructed were radiocephalic (68%) and brachiocephalic (24.9%). The median follow-up period was 275 days. The cumulative patency rate at 1 year and 2 years was 76% and 51%, respectively. Altogether, 188 complications occurred in 16% of the AVFs. Aneurysms, failure to mature, and thrombosis were the most frequent complications occurring in 27.65%, 14.89%, and 10.63% of cases, respectively. The management options for the complications included the creation of a new access for 63 complications (33.51%) and nonoperative management in 44.14% of the cases. We found no adverse effect of comorbid factors like diabetes mellitus (χ(2) = 3.58, P > 0.05) and HIV-positive status (χ(2) = 0.64, P > 0.05) on the complications rate. CONCLUSION: According to our patients' characteristics, there is a possibility of constructing AVF on nearly every hemodialysis patient with a good outcome.

Surgical repair of a giant isolated inflammatory aneurysm of the left common iliac artery.

Isolated aneurysms of the iliac artery (IA) are very rare. Inflammatory aneurysms are also rare conditions, making the association rarer. Only four cases of isolated inflammatory IA aneurysms have been reported in the last decade. In this article, we report a case of a 62-year-old patient with a 13-cm large isolated inflammatory aneurysm of the left common IA associated with a 2.5-cm right common IA involvement. The patient presented with a left lower quadrant pain, a pulsatile mass with bruit, as well as a left hydronephrosis secondary to the ipsilateral ureter entrapment, and a motor and sensory deficit of the left lower extremity. An aortoiliofemoral prosthetic repair associated to a left to right ureteral transposition was undertaken with an approach including a laparotomy and bilateral femoral artery exposure. The postoperative period was uneventful. The case mentioned in this study is probably the largest IA aneurysm ever described.

Surgical repair of a giant pseudoaneurysm of the right common carotid artery following a gunshot.

Common carotid pseudoaneurysms are very rare. The authors report a case of a 18-year-old patient with 11 cm large posttraumatic pseudoaneurysm of the right common carotid artery caused by a gunshot in the neck. The patient also had a right hemiplegia, secondary to the left sylvian artery stroke and aphasia. A surgical repair was undertaken with an approach including a total sternotomy. The aneurysm was excluded and a saphenous vein patch was used to repair the 2-cm defect on the arterial wall. The postoperative period was uneventful. This is probably the largest carotid artery aneurysm ever described. The potential hazards of an aneurysm of the common carotid artery indicate that surgical treatment is warranted particularly in a patient with a past history of controlateral stroke.

Analysis of epidemiology, lesions, treatment and outcome of 354 consecutive cases of blunt and penetrating trauma to the chest in an African setting.

BACKGROUND: The proportion of death and disability related to trauma is increasing in Third-World countries. Thoracic trauma is significantly involved, but few data are available on this issue in African countries with specific local conditions. METHODS: The aim of the study is to analyse the diagnosis and management procedures in thoracic trauma in a typical African country. The records of 354 patients admitted to an emergency unit for chest trauma over a 13-year period were retrospectively analysed. RESULTS: The sample included patients with 231 cases of blunt and 123 of penetrating trauma to the chest; their mean age was 41.86 years, and the male:female ratio was 4.2:1. The majority (N=226) of the injuries were sustained in road traffic accidents, and the most common lesions were rib fractures (50.3%) and haemothorax (38.7%). The diagnosis was based on physical examination and standard chest radiographs in most cases. At least one associated lesion was found in 260 (73.45%) patients. The mean injury severity score (ISS) for our patients was 16.39. Most patients were managed conservatively (N=303); thoracotomy was performed mostly on penetrating trauma patients. Morbidity occurred in 49 patients, mainly affecting those treated with thoracic drainage, and 27 patients (7.6%) died. Factors related to mortality were ISS score and association with neurotrauma. CONCLUSIONS: Chest trauma can be managed in our Cameroonian environment, with morbidity and mortality comparable with that of Western countries. Diagnosis must still rely on physical examination, chest radiographs and thoracic echography, which are affordable tools.

Retained sponge after abdominal surgery: experience from a third world country.

BACKGROUND: Retained abdominal sponge after surgery is a quite rare condition which can have heavy medico-legal consequences; its frequency is generally underestimated. Few reports of these conditions are available in African environment with specific technical and medico-legal background. We present our local experience of retained sponges after abdominal surgery and review current literature. METHOD: A retrospective analysis of the medical files of 14 consecutive patients with a retained surgical sponge after abdominal and urological surgery. RESULTS: The incidence was 1every 677 abdominal operations; no metallic foreign body described, only sponges; the female sex predominated with 10/14 patients. 85.71% of retained sponge occurred after an emergency procedure and 64.28% were gynecological or obstetrical procedures. Most cases presented as intestinal obstruction, localized persistent pain or abdominal mass and pre-operative diagnosis could be done only in 28.57% of cases. A falsely correct sponge count was reported in 71.42% of cases 92.85% of patients were re-operated and the morbidity was low; no death was reported. None of our cases ended in a medico-legal claim despite proper counseling. CONCLUSION: The incidence of retained sponge might be significantly higher in an environment with reduced medico-legal threat; most cases of retained sponges are still related to human errors; the incidence will probably be reduced by a greater awareness about the condition.

Extracranial carotid arteries aneurysms in children: single-center experiences in 4 patients and review of the literature.

BACKGROUND: Extracranial carotid artery aneurysms (ECAAs) are very rare conditions in children but carry a great potential of thromboembolic episodes and ruptures. METHODS: To determine the clinical and therapeutic characteristics of ECAA in children in our department, we reviewed the patients' records and completed the data from phone correspondence, written survey, and clinical examination. RESULTS: From January 1981 to June 2006, 4 patients younger than 18 years were surgically treated for ECAA in our department. They were 3 boys and 1 girl. A medical history of tonsillectomy was reported in 3 patients. The aneurysm was symptomatic in all of the patients, local signs being present in every patient. The aneurysm caused hemispheric symptoms in 1 patient and finally stroke. The aneurysms were located in the common carotid artery, in the external carotid artery, and 2 in the internal carotid artery. The cause was congenital, mycotic, and traumatic (post tonsillectomy); for 1 patient, the etiology remained unknown. Aneurysm resection and interposition with vein graft were performed in 3 patients. The external carotid artery aneurysm was resected without reconstruction. There was no perioperative death or stroke. During the early follow-up period, 1 patient had a transient dysphagia and another a transient facial palsy. The patient with preoperative stroke remained with a neurologic deficit. All these patients were followed since the operation. The patient operated on in 1981 is asymptomatic after 25 years, but the graft became occluded 3 years after the operation. The patient who had recurrent attacks is still with residual neurologic deficit. The 2 other patients are without complains; the reconstructions remain patent. CONCLUSION: Although very rare, ECAA can be encountered even in the pediatric population. The past medical history may reveal a tonsillectomy, although the relation may not be easy to establish. Local signs may be accompanied by hemispheric thromboembolic complications, rupture, and bleeding. Therefore, surgical treatment is indicated, but can be challenging according to the anatomical location of the aneurysm.