Causes of deaths in the intensives care unit of Sylvanus Olympio Teaching Hospital, Lomé, Togo.

To analyze the causes of deaths in the intensive care unit (ICU) at the CHU Sylvanus Olympio (CHU SO) teaching hospital of Lomé. This retrospective study examined the files of patients who died in the ICU of CHU SO, during the 12-month period from November 2012 to October 2013. Of 732 patients admitted to the ICU, 237 died, for a mortality rate of 32.38%. Men accounted for 163 (68.8%) of the deaths, and women 74 (31.2%), for a M/F ratio of 2.2. The average age of patients who died was 41.7 years; the age group 21-30 years comprised 16% of the deaths, that 31-40 years 19.8%, and 41-50 years 17.7%. Trauma (50.64%) dominated the causes of death, including especially severe traumatic brain injury (34.18%), followed by postoperative intensive care (25.32%), including peritonitis (8%). Medical diseases accounted for 18.14% of ICU admissions. More than half the deaths (55.7%) took place in the 72 hours after ICU entry. Mortality in the ICU at CHU SO of Lomé remains very high. It affects young patients, mainly with traumatic and surgery-related pathologies.

Improvised Vacuum-Assisted Closure for severe neck infection in poorly equipped conditions.

INTRODUCTION: Dental infections are common and are mainly due to dental caries. When left untreated, these infections can lead to severe life-threatening sepsis. CASE REPORT: The authors reported a case of a severe odontogenic deep neck space infection in a 54-year-old male. The patient was a heavy smoker with incidentally discovered diabetes. He was successfully treated by surgical drainage combined with an improvised Vacuum-Assisted Closure (VAC) system. The results of surgical drainage followed by insertion of an improvised VAC system were spectacular. The abscess resolved in response to dual-agent antibiotic therapy on day 17 and blood glucose control was achieved with insulin. Full-thickness skin graft was performed to repair the necrotic zone of the neck. DISCUSSION: The use of VAC can be a valuable alternative to conventional dressings and hyperbaric oxygen therapy in poorly equipped conditions. Public awareness campaigns remain the most effective form of prevention against these odontogenic infections.

[The gingivo periosto plastic surgery with osseous substitute: Technique and first results]. / La gingivopériostoplastie avec substitut osseux : technique et premiers résultats.

INTRODUCTION: Ortho dontico-surgical coverage of alveolar crack is essential in reason of its repercussions on facial growth and implementation of children's teeth set. We proposed to realize a premature gingivo periosto plastic surgery from 4 years old by osseous substitute to lower age of alveolar cracks closure and decrease the morbidity of patients. PATIENTS AND METHODS: We conducted a retrospective study over one year (January, 2012 to December, 2012), with six months postoperatively outcomes, on 23 cases of gingivo periosto plastic sugary with osseous substitute type glass by bone transplant at infantile plastic surgery service of Timone - Children teaching hospital of Marseille, France. RESULTS: We held 23 patients. Seventeen children, 12 boys and 5 girls presented unilateral cracks. Twenty patients required a quantity of glass bone under 1cc for the narrow cracks. Prevalence of the mucous cracks was low (4 cases on 23). Technique of gingivo periosto plastic surgery with osseous substitute is simple and our results are globally satisfactory. We observed less morbidity of the operating site. CONCLUSION: The first results of this study showed that gingivo periosto plastic surgery with osseous substitute glass bone is a simple, reliable and reproducible technique, with promising results. Reduction of site's morbidity by osseous transplant, accessibility of glass bone cost and simplicity of surgical gesture justified adoption of this technique.

Incidence of hypoxia and related events detected by pulse oximeters provided by the Lifebox Foundation in the maternity unit at Sylvanus Olympio University Teaching Hospital, Togo.

In recent decades anesthesia safety has not been improved in low-income countries. This prospective audit describes the incidence of hypoxia and related events detected among a cohort of patients undergoing surgery in the maternity unit at Sylvanus Olympio University Teaching Hospital, Togo, West Africa, by using pulse oximeters donated by the Lifebox Foundation. The Lifebox oximeter enables early detection of hypoxia for patients undergoing surgery before irreversible damage occurs. Pulse oximetry is cost-effective intervention and should be more accessible in all operating rooms of this type.

[Neurological manifestations of Gougerot and Sjögren disease: a Black African case]. / Les manifestations neurologiques du syndrome de Gougerot et Sjögren: à propos d'un cas en Afrique noire.

Primitive Gougerot-Sjögren syndrome (PGSS) is a systemic autoimmune exocrinopathy in which twenty percent of affected patients develop neurological manifestations. It has been little described in the Black African literature. We report a case of PGSS in a 64-year-old Black woman as revealed by neurological manifestations in an inflammatory context. Central neuropathy was present and the patient fulfilled at least four of the six Vitali American-European diagnostic criteria. There were abnormal aspects on the sylvian artery and hyperintense lesions of periventricular predominance. PGSS is a serious disease which we must consider when we encounter any unexplained neurological manifestations especially those associated with vasculitic lesions.

[Iatrogenic palatine necrosis by embolization of sphenopalatine arteries during management of a rebel epistaxis]. / Nécrose palatine iatrogène par embolisation des artères sphéno-palatines au décours du traitement d'une épistaxis rebelle.

INTRODUCTION: The treatment of epistaxis sometime requires an embolization. This may result in ischemic palate necrosis, oronasal communication and dental losses. The repair of these lesions is complex. OBSERVATION: A 53-year-old patient, suffering from high blood pressure and hypercholesterolemia, benefited from bilateral embolization of the sphenopalatine arteries in order to treat a persistent epistaxis. He developed a middle cerebral artery stroke in the aftermath. During the treatment of the neurological sequelae, a necrosis of the 2/3 of the posterior aspect of the hard palate was discovered. The angio-MRI showed an obstruction of both sphenopalatine arteries and of their vascular supplies resulting in a bilateral involvement of the alveolar bone. The diagnosis of iatrogenic palate necrosis was made. Tissue repair was successfully achieved by two loco-regional flaps. The dental rehabilitation was made by mean of a removable prosthesis. DISCUSSION: Palatine necrosis following embolization of the sphenopalatine arteries is uncommon. Ischemia resulted in a loss of substance in form of a punch, similar to noma's lesions. It could also be a consequence of the vascular background. The management of these lesions is complex and calls for forensic reflection about the iatrogenic origin.

Crush syndrome chez l'adulte et problematique de sa prise en charge a la phase aiguë.

Le crush syndrome se définit comme l'ensemble des manifestations locales et générales secondaires à une rhabdomyolyse traumatique avec ischémie de grosses masses musculaires par compression prolongée, à l'origine d'un syndrome compartimental ou syndrome des loges. Rarement isolé, il peut passer inaperçu dans les 24 à 48 premières heures de la phase aiguë d'un traumatisme sévère quand les principales préoccupations médicales sont la sauvegarde des fonctions vitales. La souffrance musculaire liée au syndrome compartimental entraîne la libération de myoglobine dans la circulation générale. La précipitation de la myoglobine dans les tubules rénaux est un facteur de tubulopathie, s'ajoutant à l'atteinte ischémique éventuelle, concomitante du traumatisme initial. Il s'ensuit une insuffisance rénale aiguë avec, entre autres, acidose et hyperkaliémie. Le crush syndrome constitue une urgence médico-chirurgicale, récurrente et d'actualité lors des catastrophes, mettant en exergue tous les problèmes de prise en charge de ce syndrome. Le remplissage précoce et important, vise à restaurer et maintenir une normovolémie et un débit urinaire de 1 à 2 ml/kg/h, en s'aidant au besoin de diurétiques et de bicarbonate afin d'éviter l'émission d'urines acides, dans le but d'éviter la précipitation de myoglobine et l'apparition de l'insuffisance rénale. Si celle-ci survient, l'usage précoce de l'Épuration Extra Rénale (EER « prophylactique ¼) peut permettre une réalimentation rapide, adaptée au traumatisme initial ou de nécessité en vue d'une alimentation équilibrée. La levée chirurgicale (aponévrotomie) de la compression musculo-vasculo-nerveuse est une urgence vitale pour le membre concerné. Le syndrome de revascularisation lors de la décompression (par levée de garrot ou post chirurgicale) peut entraîner un arrêt cardiaque irréversible par hyperkaliémie sur terrain hypovolémique et choqué.

[Anesthesia for upper limb surgery in a developing country: experience of infraclavicular and axillary blocks under neurostimulation]. / Anesthésie pour chirurgie du membre supérieur dans un pays en développement : expérience des blocs infraclaviculaire et axillaire sous neurostimulation.

ABSTRACT: Despite advances in regional anesthesia under ultrasound guidance, neurostimulation remains the primary technique in underequipped locations. MATERIAL AND METHODS: We conducted a prospective descriptive study from January to December 2010 and June 2011 to May 2012 with as our main objective the assessment of the practices of infraclavicular and axillary nerve blocks (ICB and AXB, respectively) at Sylvanus Olympio University Hospital. RESULTS: 105 patients (11.8%) received ICB) and 75 patients (8.5%) axillary blocks (AXB). The average minimum intensity of neurostimulation was 0.4 mA (range: 0.25-0.45 mA. The mean volume of 0.5% bupivacaine used was 30 ± 10 mL. The mean onset time of the block was 15 ± 10 min, and the mean duration of action 6 ± 4 hours. Postoperative pain was significantly worse in patients who received ICB compared to AXB [χ(2) = 19.034, p = 0.00001<0.05]. The cost of either type of locoregional anesthesia under neurostimulation compared with general anesthesia was 44 euros versus 105 euros. CONCLUSION: Peripheral nerve block by ICB and AXB under neurostimulation showed significant difference in terms of postoperative analgesia efficiency. Locoregional anesthesia remains too rarely practiced in underequipped countries despite its benefits and although it is particularly appropriate for these countries.

[Severe differed respiratory depression after intrathecal administration of morphine and clonidine on a 70-year-old patient]. / Dépression respiratoire sévère tardive après administration intrathécale de morphine et de clonidine chez un patient de 70 ans.

We report a case of severe and differed respiratory depression to a 70-year-old patient after spinal anaesthesia for prostatic adenomectomy. Ten milligram of bupivacaine, 30 microg of clonidine and 100 microg of morphine has been administrated intrathecally. The anaesthesia has lasted 4h and, 16h after the induction, the patient had a respiratory depression with bradypnea (5c/min), hypoxia (SpO(2) 80%) and sedation (scale 3 of Wilson). The evolution was favourable after intravenous injection of naloxone and oxygenotherapy. The use of low dose intrathecal morphine can involve a respiratory depression. Intrathecal association of morphine and clonidine must be careful used among old patients and require a monitoring during the first 24h.