[Lung cancer with heart failure--a cardiac and thoracic surgeon's collaboration]. / Prise en charge chirurgicale cardiothoracique d'un cancer bronchique responsable d'une insuffisance cardiaque.

Surgical resection is a validated therapeutic option for selected cases of pulmonary tumors invading the important mediastinal structures (caval vein, atrium, aorta or supra-aortic trunks). Here, we present a patient with a necrosed pulmonary tumor invading the left atrium, causing cardiac insufficiency. A complete surgical resection under extracorporeal circulation was performed by the thoracic and cardiac teams. Admitted in a bed-ridden state, the patient was discharged completely rehabilitated on postoperative day 13. He survived 1 year at home with a good quality of life.

[Vertebral primary hydatid cyst with mediastinal involvement and paraplegia]. / Kyste hydatique vertébral primitif à extension médiastinale postérieure compliquée d'une paraplégie.

INTRODUCTION: The vertebrae are the most common localization of hydatid disease of bone. This can lead to fatal consequences. CASE REPORT: We report the case of a 40-year-old-man, from a rural area, who had symptoms of medullary compression. The diagnosis of primary vertebral hydatid cyst, already suspected on the imaging data, was confirmed. A right posterolateral thoracotomy allowed drainage of the cyst and relief of the medullary compression. Medical treatment with albendazole was continued for 4 months. The postoperative course was uneventful and the symptoms of medullary compression resolved progressively. No recurrence was observed during a follow-up of 24 months. CONCLUSION: Vertebral localization of hydatid disease is the most common and serious skeletal complication. Thoracotomy allows drainage of the cyst and the pleural cavity, and relieves the medullary compression.

Prehospital transport of spinal cord-injured patients in Nigeria.

BACKGROUND: Well-organised and efficient prehospital transport is associated with an improved outcome in trauma patients. In Nigeria there is a paucity of information on prehospital transport of spinal cord-injured patients and its relation to mortality. OBJECTIVE: To determine whether prehospital transportation is a predictor of mortality in spinal cord-injured patients in Nigeria. DESIGN: Prospective cohort study. METHODS: Prehospital transport-related conditions, injury-to-arrival intervals and persons who brought spinal cord-injured patients to the casualty departments at the University of Abuja Teaching Hospital, Gwagwalada, and the National Orthopaedic Hospital, Lagos, were noted. Data were analysed using descriptive statistics, the chi-square test and multiple logistic regressions. MAIN OUTCOME MEASURES: Mortality within 6 weeks of admission. Results. During the review period, 168 patients with spinal cord injury presented to the casualty departments. Most presented 24 hours or more after the injury (67.9%) and were brought to casualty by their relatives (58.3%). Saloon cars were the most common mode of transportation (54.2%), most patients (55.4%) lying on their back during transfer. The majority of the patients (75%) had been taken to at least one other hospital before arriving at our casualty departments. The mortality rate was 16.7%. Multivariate analysis after adjusting for age, gender and means of transportation revealed that age (odds ratio (OR) 63.41, 95% confidence interval (CI) 9.24 - 43.53), a crouched position during transfer (OR 23.52, 95% CI 7.26 - 74.53), presentation after 24 hours (OR 5.48, 95% CI 3.20 - 16.42) and multiple hospital presentations (OR 7.94, 95% CI 1.89 - 33.43) were associated with death within 6 weeks of admission. CONCLUSION: Well-organised and efficient prehospital transport would reduce mortality in spinal cord-injured patients. Providing information on prehospital transport would also reduce mortality.

Prehospital transport of patients with spinal cord injury in Nigeria.

BACKGROUND: A well-organized and efficient prehospital transport is associated with improved outcome in trauma patients. In Nigeria, there is paucity of information on prehospital transport of patients with spinal cord injury (SCI) and its relation to mortality. OBJECTIVE: To determine if prehospital transportation is a predictor of mortality in patients with SCI in Nigeria. DESIGN: Prospective cohort study METHODS: Prehospital transport related conditions, injury arrival intervals and persons that brought patients with SCI to the casualty were noted. Data analyzed using descriptive statistics, the chi-square test and multiple logistic regressions. MAIN OUTCOME MEASURES: Mortality within 6 weeks on admission RESULTS: 168 patients with SCI presented in the casualty during this review period. Majority (67.9%) presented after 24 hrs of the injury. Majority (58.3%) were conveyed into the casualty by their relatives. Salon car (54.2%) was the most common mode of transportation where majority (55.4%) laid on their back during the transfer. Majority (75%) of the patients had multiple hospital presentation before reporting in our casualty. The mortality observed was 16.7%. Multivariate analysis after adjusting for age, gender, and means of transportation revealed that age (OR= 63.41, 95% CI= 9.24-43.53), crouched position during transfer (OR= 23.52, 95% CI= 7.26-74.53), presentation after 24 hrs (OR=5.48, 95% CI=3.20-16.42) and multiple hospital presentation (OR= 7.94, 95% CI= 1.89-33.43) were associated with mortality within 6 weeks of admission. CONCLUSION: A well-organized and efficient prehospital transport would reduce mortality in spinal cord injured patients. Public enlightenment campaign on factors that could reduce road traffic injury would help reduce mortality.

[Bilateral popliteal artery complications of multiple hereditary exostosis]. / Complications vasculaires poplitées bilatérales d'une exostose héréditaire multiple.

The osseous exostose is a rare benign tumor of the bone from which the vascular complications can be of venous or arterial order, are translated in various boards. We report the case of a young adult who presents a forgery aneurysm of the right popliteal artery with the popliteal artery booby-trapped to the left. The patient benefited from surgical treatment with good clinical and radiological evolution.

Complications and causes of death in spinal cord injury patients in Nigeria.

BACKGROUND: There have been many reports on the problems of spinal cord injury (SCI) in Nigeria but few have reported on the complications and causes of death in spinal cord injured patients. OBJECTIVE: The objective of this study was to determine the complications, causes of death and associated risk factors in patients with SCI within six months post injury. METHODS: Patients were retrospectively identified from the hospital trauma database from January 1997 to December 2007. Complications and cause of death within the first six months of SCI were determined along with associated risk factors. RESULTS: Five hundred and eighty-two patients were eligible for analyses and data were obtained for 422 (72.5%) patients with a mean age of 37.2 (±14.2) years at six months follow-up. Muscle spasms 417 (98.8%) and neurogenic pain 382 (94.5%) were the main complications noted. The mortality during the review period was 144 (34.1%). Respiratory failure (44.4%) was the commonest cause of death. The independent predictors of mortality were mainly age, GCS<9, Frankel Type A at presentation and cervical spine injury (CSI) and while CSI and Frankel Type A injury were the main predictors of complications. CONCLUSION: Most common complication and cause of death following SCI are muscle spasm and respiratory failure respectively. The risk factors associated with mortality are age, GCS<9, cervical spinal injury, and complete neurologic injury and those for complications were cervical spinal injury and Frankel Type A injury.

[Surgery of 56 patients having a partial atrioventricular septal defect]. / Chirurgie du canal atrioventriculaire partiel : résultats à court et à moyen terme à propos de 56 patients opérés.

Between January 1991 and December 2006, 56 patients having a partial atrioventricular septal defect (AVSD) were operated. The purpose of this retrospective study is to analyze the immediate and long-term results of the surgery by granting of the importance to two main problems which are the disturbances of the rhythm and the conduction and the residual mitral regurgitation (MR). The mean age of our patients is of 10 and a half years with a net feminine ascendancy. Ninety-three percent of the patients were in regular sinus rhythm. No case of complete atrioventricular block (AVB) was noted. The MR was of grade I in 28.5% of the cases, grade II in 60% of the cases and grade III and IV in 7.5% of the cases. The MR was mild in 4% of the cases. The correction was made under cardiopulmonary bypass (CPB) and consisted of a suture of the mitral cleft in most of the cases with lock of the ostium primum by a patch of pericardium. The perioperative mortality was 1,8% of the cases. The disturbances of the rhythm and the conduction were noted in 34% of the cases. All the patients were controlled with a mean follow-up of six years and seven months. The secondary mortality was nil. The MR, at mid-term follow-up, was mild in 78% of the cases. The partial AVSD is a congenital heart disease, the spontaneous evolution of which can be burdened by complications, notably the disturbances of the rhythm and the conduction, as well as the heart failure. This justifies a premature surgical repair.

[Effect of growth phase and composition of the medium on the rate of biosynthesis of NADH: rubredoxin oxidoreductase in Clostridium acetobutylicum]. / Influence de la phase de croissance et de la composition du milieu sur le taux de biosynthèse de la NADH: rubrédoxine oxydoréductase chez Clostridium acetobutylicum.

Among the three strains of Clostridium acetobutylicum we investigated: NRRL 592, NCIB 619 and ATCC 824, only the last was shown to contain a NADH: rubredoxin oxidoreductase activity. We report that the biosynthesis rate of this enzyme fluctuated in the proportions of 1 to 50 according to the growth phase and medium composition. These variations reflect a mode of regulation adjusted to the metabolism of bacteria.