Traitement chirurgical des omphaloceles au CHU de Yaounde

But : l'objectif de ce travail etait d'analyser les methodes de prise en charge des omphaloceles dans une formation hospitaliere africaine ne disposant pas de service de chirurgie neonatale. Patients et methode : il s'agit d'une etude retrospective descriptive qui a inclus 10 nouveau- nes presentant une omphalocele et admis au Centre Hospitalier et Universitaire de Yaounde entre Janvier 2005 et Decembre 2010. Resultat : il n'y a eu aucun patient avec un diagnostic en prenatal. Aucun patient n'a presente de malformation associee. Les formes cliniques etaient reparties en 60 de type I et 40 type II selon la classification de Aitken. Neuf enfants ont beneficie d'une prise en charge medicale pre-operatoire. Un traitement chirurgical avec fermeture parietale en un temps a ete realise chez 7 patients (78). Deux patients (22) ont ete traites avec une fermeture parietale en un temps a l'aide d'une prothese de polyester. Un enfant est decede en postoperatoire immediat sans traitement. Le taux de mortalite dans cette serie etait de 20Conclusion : le diagnostic antenatal doit etre encourage afin d'ameliorer le pronostic de ces patients dans notre contexte. La fermeture parietale en un temps semble le traitement de choix dans les omphaloceles de type I. La fermeture parietale immediate avec prothese devrait etre progressivement indiquee dans le traitement des omphaloceles en Afrique pour les omphaloceles de type II chaque fois qu'il est possible d'assurer a l'enfant la securite anesthesique et chirurgicale

[A case of unilateral dislocation of C3 right facet joint treated with lateral mass plating]. / Fracture-séparation du massif articulaire droit de la troisième vertèbre cervicale traitée par vissage des masses latérales.

Facet joint dislocations of the cervical spine are distractive-flexion injuries that account for 6 to 10 % of traumatic lesions of the subaxial cervical spine. Distractive-flexion injuries of the cervical spine were classified into four stages by Allen and Fergusson. These unstable lesions predominate at the fifth and sixth levels and all aspects of their management are subject to controversy, including their classification. Attempting reduction before surgery, performing MRI before or after closed reduction, choosing between surgery and external contention, the anterior versus the posterior approach are still matters of controversy between experts. The authors report a stage 2 distractive-flexion injury of the right facet joint of the third cervical vertebra treated by lateral mass plating as described by Roy-Camille (1995).

[Diagnosis of pheochromocytoma in Yaoundé (Cameroon): a study of nine cases]. / Phéochromocytomes au Cameroun: neuf observations.

The aim of this study was to describe methods used for diagnosis of pheochromocytoma inYaoundé, Cameroon. This retrospective study was based on analysis of the charts of patients treated in the surgical department of the Yaoundé University Teaching Hospital from 1985 to 2009. Nine patients with histologically confirmed pheochromocytoma were identified. There were 8 women and 1 man with a mean age of 39.5 years (range, 12 and 66). Pheochromocytoma was associated with hypertension in 6 cases. In two women with hypertension, diagnosis was based on palpation of an abdominal tumor after caesarean section following pregnancy associated with arterial hypertension. In another woman, diagnosis was made during laparotomy for a left hypochondrial tumor. In 7 patients, diagnosis was based on laboratory findings showing high urinary levels of vanyl mandelic acid (VMA). In six patients, ultrasound examination allowed topographic diagnosis that was confirmed by CT-scan in 3 cases. Two patients presented extra-renal pheochromocytomas in the abdomen. In three patients, i.e., one third of cases, histology showed malignant features. The findings of this study indicated that diagnosis of pheochromocytoma in Yaoundé be improved with the introduction MRI, scintigraphy, and modern techniques for assaying urinary methoxyderivates.

[Perioperative cholangiography: a case study at Yaounde (Cameroon)]. / Cholangiographie peropératoire: une observation a Yaoundé (Cameroun).

For many years peroperative cholangiography has been routinely used for bile duct surgery in the Western countries. However recent publications showing high rate of inconclusive peroperative cholangiography (47%) has cast doubt on this attitude. Surgeons in Africa and particularly in Cameroon have already replaced peroperative cholangiography with other indicators such as clinical history and preoperative echography, anticipating cholangitis. For some indications, e.g. Mirizzi syndrome, peroperative cholangiography is essential for surgery. The fluoroscopes required for this exploration should be made available in our hospitals since they are also needed for traumatology, vascular surgery, and other specialities. In addition this syndrome may be more common in our region.

Complications chirurgicales des avortements clandestins: à propos de 51 cas observés dans deux hôpitaux de Yaoundé

Le but de cette étude était de décrire les complications des avortements provoqués dans la clandestinité et imposant un traitement chirurgical. Il s'agit d'une étude rétrospective transversale portant sur les malades opérés dans les services de Chirurgie de l'Hôpital central et du Centre Hospitalier Universitaire de Yaoundé du 1er Janvier 2004 au 31 Décembre 2008. Les variables d'étude étaient l'âge, le statut matrimonial, les antécédents gynécologiques, les antécédents d'avortement antérieur, le mode, l'indication chirurgicale et l'état général des patientes; les lésions découvertes en peropératoire, leur traitement et l'évolution postopératoire. Cinquante une patientes ont été retenues pour cette étude menée pendant une durée de quatre ans, soit une moyenne de 12,7 cas par an. L'âge des patientes variait entre 15 ans et 41 ans avec une moyenne de 30 ans; 33 patientes (64,7%) avaient un âge situé entre 15ans et 25 ans. 6 patientes (11,7%) étaient multipares et 4 patientes étaient primipares (7,8%). Treize patientes (25,42%) avaient déjà subi une interruption volontaire de grossesse sans complication. Quarante-neuf patientes (96%) étaient arrivées avec un tableau de péritonite ; 43 patientes (84,22%) étaient classées ASA III (American Association of Anesthesiologists). Les lésions chirurgicales étaient à type de perforations ou de déchirures utérines dans 20 cas (39,21%), annexielles dans 9cas (17,64%), digestives dans 16 cas (31,37%) et urinaires dans 4 cas. Le traitement a associé au traitement de la péritonite, les sutures utérines, digestives et vésicales ; les gestes d'exérèse comprenaient deux hystérectomies et cinq salpingectomies. Il a été réalisé des gestes de dérivation dont deux cystostomies et deux colostomies. La mortalité était de 15,6%. L'étude recommande une éducation des femmes en matière de contraception et de planning familial, et surtout une politique sociale permettant de réduire le nombre des avortements clandestins

[Analysis of operative indications and outcomes in 238 re-operations after abdominal surgery in an economically disadvantaged setting]. / Réinterventions de chirurgie abdominale en milieu défavorisé : indications et suites opératoires (238 cas).

AIM OF THE STUDY: We analyse aspects of re-operative abdominal surgery in an economically disadvantaged environment with respect to indications, operative findings, treatment modalities, and outcomes. PATIENTS AND METHODS: Retrospective chart review over a seven-year period of patients requiring re-operative surgery during the same hospitalization or within 30 days of initial surgery. RESULTS: During the study period, 7714 laparotomies were performed. Two hundred and seventy-seven (3.6%) required re-operation; of these, 238 charts (86%) were able to be reviewed. The decision for operative re-intervention was made mainly on the basis of clinical findings. Postoperative peritonitis (50.8%), adhesive bowel obstruction (23.9%), and intestinal fistula (10.9%) were the main indications for re-intervention. Complications occurred in 35% and included postoperative infection (n=70, 33%) and abdominal wall dehiscence (n=37, 15.5%). Mortality was 18% and increased significantly when the initial operative procedure was for peritonitis and re-operation was due to septic complications. CONCLUSION: In an economically disadvantaged environment, the re-operation rate after an abdominal surgery does not seem to be higher than that seen in series from developed countries, although there may be factors which bias this observation. The mortality rate for cases with postoperative peritonitis is high, but operative re-intervention based on clinical findings is still considered the favored strategy in our environment. Results may improve with better material medical conditions.

Neural tube defects are rare among black Americans but not in sub-Saharan black Africans: the case of Yaounde - Cameroon.

BACKGROUND: Neural tube defects (NTD) are complex malformations rare in black Americans and Japanese. The incidence related to births or community-based studies have not been published in Cameroon or in black sub-Saharan countries, except one study in the Nigerian middle belt [Airede KI. Neural tube defects in the middle belt of Nigeria. J Trop Pediatr 1992;38 27-30.][corrected]. METHODS: To evaluate the incidence of neural tube defects in Yaounde, the birth record of the maternities was retrospectively exploited during the last ten years period (1997-2006). RESULTS: A total of 52,710 births were recorded in the 03 main hospitals of Yaounde. Ninety eight (98) cases of NTD with an incidence of 1.99 cases per 1000 births were registered. Spina bifida cystica (myelomeningocele, meningocele) represented 71%, followed by encephalocele (21.1%) and anencephaly (5.4%). Periconceptional folic acid was not taken by any of the mothers in our study. Abortion of affected pregnancies is illegal in Cameroon. CONCLUSION: Neural Tube Defects may not be so rare in sub-Saharan black Africans particularly in Yaounde (Cameroon). Spina bifida is the most frequent malformation. The results of this study make a case for periconceptional folic acid supplementation in our communities. The respective contributions of racial (genetic) versus environmental (or nutritional) factors will however have to be studied in order to develop a comprehensive prevention strategy.

[Abdominal gunshot wound: description of 86 cases in Cameroon]. / La plaie abdominale par balle: à propos de 86 observations au Cameroun.

Abdominal gunshot wound (AGSW) is a trauma emergency. The purpose of this report is to describe our experience with managing AGSW largely without modem investigational modalities. Data was collected retrospectively by reviewing the surgical reports and clinical charts of patients admitted to live hospitals dealing with AGSW over a 5-year period. Incomplete files and wounds not involving the abdomen were not included. A total of 86 files were analyzed. Patients ranged in age from 10 to 63 years ivith mean age of 32 years and a sex ratio of 5.5. Most patients (87%) underwent surgical exploration. Laboratory revealed no lesions in 22.5% of cases, minor lesions in 9.5% and major lesions justifying surgical repair in 68%. A total of 86 visceral lesions were found in the patients who underwent surgical exploration. The lesion involved the small intestine in 31.5% of case, colon in 24.5%, liver in 23.5%, spleen in 7%, stomach in 6%, and uterus in 2%. The kidney, pancreas, mesenteries, large momentum, and transverse mescaline each accounted for 1% of lesions. Conventional operative techniques were used with a mortality of 5.5% and morbidity of 4%. Based on our findings we conclude that when investigational tools (CT-scan, peritoneal lavage and laparoscopy) are unavailable prolonged watchful waiting increases the risk of mortality and morbidity in patients presenting AGSW associated with suspicious clinical signs. Prompt surgical treatment improves prognosis but is associated with a high rate of cases showing no lesions.

[Are health care facilities in Cameroon compatible with rational management of emergency patients?]. / La carte sanitaire au Cameroun est-elle compatible avec une prise en charge rationnelle des urgences?

The aim of this month-long cross sectional study was to evaluate the preparedness of health care institutions in Cameroon to provide rational management of emergency patients. During January 2002 a survey was carried out to list all health care institutions offering emergency care services and to determine their other departments and available equipment and staff. A total of 144 institutions with emergency care facilities were found including 12 central reference hospitals and 123 district hospitals equipped to provide primary emergency care. In relation to a population of 15 million inhabitants, the ratio was one reference hospital for 104180 inhabitants and one district hospital for 100,000 inhabitants. None of the services involved in emergency management had facilities for emergency treatment on an outpatient basis. Regarding hospital-based services, an emergency ward was available at the 12 central reference hospitals for a ratio of one ward for 1,250,000 inhabitants. This ratio was 10 times higher than in France in 1994. Almost all major equipment and trained personnel for emergency care medicine were concentrated at the central reference hospitals but these resources were insufficient to organize round-the-clock services except at a single site. The findings of this survey indicate that the distribution of health care facilities in Cameroon was relatively adequate in relation to population density but that equipment and human resources were still insufficient to provide rational management of emergency patients.

[Emergency medical training: the future of emergency care in Africa?]. / Capacite de medecine d'urgence: avenir des urgences en Afrique?

The main goal of emergency medicine training is to teach the wide range of sciences and skills necessary to recognize and stabilize emergency situations. Emergency medicine training has proven highly effective in developed countries especially with regard to organization of survival medicine. This type of training is especially important in sub-Saharan Africa where there is a severe shortage of intensive care specialists and an almost total lack of other personnel qualified to manage life-threatening trauma and disease. Starting with the 1998 Nsam fire disaster in Yaounde, a number of situations have confirmed the seriously deficient state of resources for handling emergencies in Cameroon. In view of this situation a two-year study program in emergency medicine was proposed and introduced at the School of Medicine and Biomedical Sciences of the University of Yaounde I during the 2000/2001 academic year. The curriculum includes eight 40-hour didactic course modules and 800 hours of hands-on work in local hospitals and in France. Students undergo regular assessment of their scientific knowledge and practical competencies after each module. As additional prerequisites for the diploma, they must be certified in first aid and rescue and present a research paper. Despite the lack of faculty and teaching materials, this program is expected to increase the number of emergency medical care providers and improve access to high-quality emergency care services.

[Transfusion practices and quantification of blood loss in a surgical setting in Cameroon]. / Etude des pratiques transfusionnelles et quantification des pertes sanguines en milieu chirurgical Camerounais.

The purpose of this prospective study was to analyze compliance by surgical teams with new guidelines for blood transfusion. Study was focused on routine, presumably hemorrhagic procedures performed electively in adults at the Central Hospital in Yaounde, Cameroon. Overall blood loss was less than 20% of the total volume in 89% of the 303 patients included. Blood loss was between 20 and 30% in 10.6% and greater than 30% in 0.3%. Administration of replacement blood products was warranted only in the last two groups. Blood transfusion was performed in 104 patients and was unjustified in 81.7%. Seven percent of the remaining 199 patients presented indications for transfusion which was not performed and not compensated for by appropriate alternative precautions. At least one unit of whole blood had been requested and delivered to the operating room in 70% of cases with blood loss less than 20%, but was used in only 45% of cases. This study demonstrates poor compliance with new guidelines for blood transfusion in the surgical setting. Overconsumption of blood products represents the main problem. These findings underline the need for wider teaching of new blood transfusion strategies. Interest in this information is usually great in developing countries where blood banks are faced with limited facilities, qualified personnel, and supplies.

[Treatment of early T1 small T2N breast cancers. Our experience at the Yaounde General Hospital. 21 cases]. / Traitement des cancers du sein aux stades précoces T1 petit T2 N-notre experience a l'Hôpital Général de Yaoundé. A propose de 21 cas.

From February 1989 through February 1993, a group of 23 patients suffering from T1 mammary carcinoma small T2 N-MO was treated in the radiotherapy department of the Yaoundé General Hospital, according to a simplified procedure. A first conservative surgery of tumorectomy type (3 cases) and quandrantectomy type (4 cases) was carried out, followed by a postoperative irradiation. In 14 cases, a Patey type radical surgery preceded a local/regional radiotherapy. The general treatment was made up of only a hormonotherapy without chemotherapy. After a 4-year decline, there were 5 cases--i.e. 23.8%--of ganglionic and/or metastatic relapse. In the light of research data, we are analysing the reasons for these unexpected therapeutic failures in this group of tumor considered as favorable prognosis. We raised the problem of the inability of the prognosis factors, presently defined by means of histological and biological factors, to detect all the especially aggressive cancers. We carried out a general review of the new factors defined essentially from molecular and genic bases. We offered an approximative solution which makes it possible to by-pass the technological difficulties in having access to the new factors.

Testes tumors in a Sub-Saharan African city (Yaounde). Incident cases and histopathology.

OBJECTIVES: To determine the histologic types of testicular tumors and identify associated risk factors. METHODS: Data on clinical presentation, age, race, history of cryptorchidism or testicular trauma and histologic types, on each patient with testis tumor, were abstracted from medical records and the pathology register. RESULTS: Of 14 tumors, 11 were malignant. Five were Burkitt's and 2 non-Burkitt's lymphomas, 1 plasmocytoma and 3 seminomas. None of the seminomas occurred in black Africans. CONCLUSION: The epidemiology and histology of testis tumors in Yaounde differs considerably from other reported series. Burkitt's lymphoma is the commonest tumor. This alters the approach to the management of testicular masses. Race and geography seem to be important in the occurrence of testes tumors.

[Developing cancer from a probable misdiagnosed pancreatic cystadenoma]. / Cancérisation d'un probable cystadénome pancréatique méconnu.

This paper reports the malignant transformation of a benign pancreatic cyst treated by internal drainage in a 30-year-old woman. The initial lesion was diagnosed on surgical biopsy of the cyst wall. The diagnosis of pancreatic carcinoma was made after one year of satisfactory course, by fine needle cytologic aspiration of the fibrous retraction of the cyst; at that time the patient had severe pancreatic pain with multinodular liver on ultrasonography. The conclusion is the recommendation of total excision of pancreatic cysts whenever the diagnosis is incomplete or imprecise.

Interet du traitement chirurgical de la cryptorchidie a Yaounde

Une etude retrospective visant a evaluer l'interet du traitement chirurgical de la cryptorchidie a porte sur 123 patients operes a Yaounde pendant une periode de 10 ans allant de 1984 a 1994. L'analyse a revele que 93 patients (75;6 pour cent) avaient ete operes apres l'age de trois ans; au moment ou des alterations histologiques avaient deja compris le pronostic fonctionnel du testicule et augmente le risque de cancerisation. Des resultats comparables dans la litterature montrent l'insuffisance de l'information medicale sur l'age optimal de l'abaissement des testicules cryptorchides. L'etude fait des propositions pour un changement de comportement

Maladie ulcereuse gastro-duodenale : acces aux moyens de diagnostic et de traitement en milieu tropical

Une etude prospective portant sur l'analyse des antecedents de 72 malades operes au CHU de Yaounde d'un ulcere gastro-duodenal complique avait pour but d'evaluer l'acces des malades aux moyens de diagnostic et de traitement pendant la maladie ulcereuse et pendant les complications. Les stenoses etaient la complication chirugicale la plus frequente (69;4 pour cent) devant les hemorragies (16;6 pour cent) et les perforations chez 43 malades (59;7 pour cent). Les examens diagnostiques avaient ete demandes chez 25 malades (34;7 pour cent); dont 9 TOGD et 6 fibroscopies; chez les 15 malades ayant eu une complication sur un ulcere connu; 5 malades (33;3 pour cent) avaient pu suivre dans le passe un traitement medical correct. Avec la survenue des complications; tous les malades ont eu acces aux moyens de diagnostic; dont 50 TOGD et 6 fibroscopies pour le diagnostic des hemorragies et et 8 radiographies de l'abdomen sans preparation pour le diagnostic des perforations. Apres le traitement chirurgical 6 malades (8;5 pour cent) ont poursuivi un traitement medical correct pendant 45 jours. En conclusion; cette etude montre que peu de malades souffrant de maladie ulcereuse gastro-duodenale ont acces aux moyens modernes de diagnostic et de traitement en milieu tropical. Une meilleure politique sanitaire s'impose en vue de controler cette maladie avant la survenue des complications

Une demarche diagnostique des cancers du pancreas exocrine en milieu tropical

Il s'agit d'une etude sur 14 patients et visant a proposer a des malades a faible pouvoir d'achat une demarche diagnostique adaptee a un environnement sous-equipe en materiel et en personnel specialise. Les sequences clinique-echographie-cytoponction percutanee et clinique-echographie-laparotomie ont permis le diagnostic de 13 cancers du pancreas; ce diagnostic etait utilement complete par les donnees d'une laparotomie permettant un traitement palliatif sans aggravation du pronostic

[Diagnostic problems apropos of 2 clinical cases of lumbar Pott's disease]. / Problèmes diagnostiques à propos de deux cas cliniques de mal de POTT lombaire.

Two cases of POTT's disease without radiological osteoarticular destructions have been diagnosed from a psoas and a dorsal abscess. Bacteriology and histology were negative at the beginning, then became positive after a long evolution of the wound. The recommendation is to think of POTT's disease when confronted with any paravertebral abscess, with or without radiological signs and to repeat the bacteriological and histological tests if necessary.

[Malaria and post operative fever in the University Hospital Center of Yaounde (Cameroon)]. / Paludisme et fievre post-operatoire au Centre Hospitalier et Universitaire de Yaounde (Cameroun).

This study from a series of 80 patients showed that the prevalence rate of malaria increased from 8% before to 15% after surgery in the tropics. The difference was not significant (p < 0.05). The conclusion is that patients should be investigated for malaria parasites before any major surgery; in case of a non infectious post-operative fever, antimalarial drugs should be prescribed only to patients with a positive thick film.

Influence des fils de suture sur les infections post-operatoires de la paroi abdominale

Repartis en deux groupes; 145 malades ont ete operes de chirurgie abdominale dans les memes conditions d'asepsie et suivis pendant 6 mois. Dans le premier groupe comprenant 75 malades; le plan musculo-aponevrotique etait suture aux fils synthetiques a resorption lente et il y aeu 6;6 pour cent d'infections parietales. Parmi les 70 malades du second groupe sutures avec des fils non resorbables; il ya eu 18;5 pour cent d'infections parietales. La difference etait significative; ce qui permet de recommander l'utilisation des flis synthetiques a resorption lente dans la fermeture de paroi abdominale en zone tropicale ou les conditions d'asepsie parfaite sont difficiles a reunir