[Cardiac surgery in Cameroon. Results at one year of the pilot phase]. / Chirurgie cardiaque au Cameroun. Résultats à un an de la phase pilote.

In the framework of implementation of his national program for control and prevention of cardiovascular diseases, Cameroonian government has set up a cardiac surgery project. We report in this manuscript results of one year follow up of the patients operated during the pilot phase. From September 22 till 26, 2008, 11 patients have been operated in Cameroun. Surgical procedures were 5 mitral mechanic valve replacement, 2 aortic mechanic valve replacement, 1 atrial septal defect closure, 2 pace maker implantation. No intrahospital death was observed. One patient died at 11th month after the operation due to mitral valve thrombosis and attributed to lack of compliance. One patient presented low cardiac output, pneumonia and a pleural effusion. 2 patients presented 2 minor complications consisting of pericarditis and superficial wound infection. The results of the pilot phase of cardiac surgery in Cameroon are effective. However, the sustainability of the program require human, material capacity building, and funding mechanism as well.

[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.

[Results of the first three years of operation of the emergency medical assistance service (SAMU) in Yaounde, Cameroon]. / Bilan des trois premieres années d'activités du SAMU de Yaoundé (Cameroun).

PURPOSE: The purpose of this article is to present the results of a descriptive and retrospective study of the operations of the emergency medical assistance service (SAMU) in Yaounde, Cameroon. METHODS: Medical regulation and intervention records and monthly statistics forms were analysed for the period going from the creation of the SAMU in 2004 to March 2007. Study was limited to call reception, medical regulation, and extra-hospital and training activities. Study focused on operations and services. RESULTS: The SAMU in Cameroon is managed by a pilot committee presided by the Minister of Public Health and headed by a technical executive secretary. The single phone number to contact SAMU Yaoundé is 19 (119). When a call comes, the personnel on duty in the regulation room identifies the caller and either gives a non-medical response or transfers the call to an on-call emergency doctor who decides whether or not on-site intervention is required. In the 3-year study period, the SAMU received 50,822 calls per year (mean, 1694 +/- 2195). There were 1 596 prank calls (3.14%), 31 044 (61.08%) calls requesting non-medical information, and 2054 (4.04%) calls requiring on-site intervention. The number of calls decreased by 23% from the first to third year of operation. The number of on site-interventions carried out by Yaoundé SAMU was 578 in the first year, 651 in the second and 825 in the third year. A total of 1555 interventions were carried out including 142 that ended in no action and 107 that ended in late arrival. Road traffic accidents were the main reason for intervention. Only one training session was organised for the personnel during the first year of operations. CONCLUSION: The SAMU Yaoundé is based on the French model (on-site care). The number of calls has dropped from the first to third year but the number of prank calls has also decreased. Road traffic accidents accounted for most of the on-site interventions. Further work is needed to increase public awareness of the importance of the SAMU and to provide training for SAMU personnel.

[Detection of gas embolism in neurosurgery by capnography. Apropos of 32 patients surgically treated in seated position]. / Détection des embolies gazeuses en neurochirurgie par la capnographie. A propos de 32 patients opérés en position assise.

Hitherto dreaded and dreadful, air embolism has since the past few years a better prognosis owing to new techniques of early detection. The present study concerns a series of 32 neurosurgical patients who were operated in the sitting position under continuous capnography. This method not only provides global monitoring (metabolic, haemodynamic and respiratory) but also allows early detection of any significant migration of air or gas into the blood vessels. The incidence of air embolism in this series was 31% (10 patients out of 32). The onset of air embolism was diagnosed on a rapidly progressive fall in the expired fraction of CO2 (FECO2), in spite of a normal blood pressure. Early treatment prevented further complications. Therefore capnography is a sensitive and reliable method of air embolism detection intraoperatively. Its use in the operating room and intensive care unit should be systematic whenever air embolism may occur.

[Cerebral malaria in children in Cameroon. Apropos of 11 cases]. / Neuropaludisme de l'enfant au Cameroun. A propos de 11 cas.

Eleven cases of cerebral malaria were observed among 106 hospitalized malarian children. A brief recall of pathophysiology is given, including its immunological aspect. Symptomatology and course of this severe form are evoked. All children were treated by IV then oral quinine and recovered without any neurological sequelae. The importance of a very early treatment is strongly emphasized.

L'experience camerounaise en chirurgie cardiaque: a propos de 83 cas operes de 1985 a 1990

La chirurgie cardiaque a ete introduite au Cameroun en 1985 au CHU de Yaounde. Six missions de chirurgie cardiaque ont ete effectuees au Cameroun de juillet 1985 a avril 1990. Nous nous sommes proposes d'evaluer cette experience initiale dans notre pays et d'essayer d'etablir la courbe de survie des patients operes cardiaques. L'etude a ete essentiellement menee au CHU de Yaounde. Au total; 83 sujets dont 42 femmes et 41 hommes ont ete operes. Leur age varie de 9 a 60 ans avec une moyenne de 29 ans. Parmi ces malades 53 pour cent des sujets etaient au stade fonctionnel III et IV de la NYHA en preoperatoire et 95;3 pour cent presentaient une insuffisance cardiaque refractaire au traitement medical. Les remplacements valvulaires sur valvulopathies post-rhumatismales representaient la principale indication (77 cas). 4 cardiopathies congenitales (1 communication interauriculaire; 1 communication interventriculaire et 2 canaux arteriels persistants); 5 pericardites (2 constrictives; 1 serofibrineuse et 1 purulente) et 1 endomyocardite fibreuse ont egalement ete repertoriees. Les resultats ont ete remarquables; car ils ont permis a une grande majorite d'operes une survie d'au moins 5 ans. Cependant; le cout de la chirurgie cardiaque reste toujours eleve quoique de loin preferable a celui d'une evacuation sanitaire a l'etranger

L'experience camerounaise en chirurgie cardiaque: a propos de 83 cas operes de 1985 a 1990

La chirurgie cardiaque a ete introduite au Cameroun en 1985 au CHU de Yaounde; sous l'egide du Ministere de la Sante Publique et grace a l'impulsion de quelques pionniers camerounais; avec la collaboration des equipes chirugicales francaises de Lyon et de Marseille. Nous nous sommes proposes d'evaluer cette experience initiale dans notre pays et d'essayer d'etablir la courbe de survie des patients operes cardiaques. Au total; 83 sujets ont ete operes. leur age varie de 9 a 60 ans avec une moyenne de 29 ans. Parmi ces malades 53 pour cent des sujets etaient au stade fonctionnel III et IV de la NYHA en preoperatoire et 95;3 pour cent presentaient une insuffisance refractaire au traitement medical. [abstract terminated]

Profil lipidique general d'un groupe de malades insuffisants renaux chroniques camerounais

Dans un groupe de 52 malades insuffisants renaux chroniques; nous avons mesure les lipoproteines de haute densite (HDL); les lipoproteines de basse densite (LDL) et les triglycerides (TG); le cholesterol total (CT) ainsi que le quotient CLDL/CHLD qui mesure le risque atherogene. Les valeurs moyennes montrent que l'hyperlipidemie est constante dans l'insuffisance renale chronique (IRC) a Yaounde et 61 pour cent des malades du groupe etudie sont a risque atherogene

[Utilization of laryngeal masks. Preliminary study. 21 cases. Department of Anesthesia-Resuscitation, Yaounde, Cameroon]. / Plaidoyer pour l'utilisation du masque laryngé. Etude préliminaire. A propos de 21 cas. (Département d'Anesthésie-Réanimation, Yaoundé Cameroun).

The authors present a preliminary and retrospective study about the utilization of laryngeal mask. 21 patients underwent surgery concerning short or mid term intervention. A positioning of a laryngeal mask was easy with 83 p.c. of success. Although no shortcomings appeared in this series, one must know such a possibility and must take it into considerations. Not at all replacing endotracheal intubation, the laryngeal mask is in peculiar situations an other possibility of protection of respiratory tract, and of ventilation be spontaneous manual or mechanical. The advantages of laryngeal mask versus facial one are obvious.

[The detection of gas embolisms in neurosurgery caused by joint monitoring with capnography and the Swan-Ganz probe. (Apropos of 7 patients operated on in the sitting position]. / Détection des embolies gazeuses en neurochirurgie par le monitorage couplé capnographie-sonde de Swan-Ganz. (A propos de 7 patients opérés en position assise).

The aim of this study was to detect per-operative venous gas embolism in neurosurgery using capnography coupled to the Swan-Ganz catheter method. Using both methods, our study, carried out on seven patients operated in the sitting position, showed an occurrence of air embolism in four cases. The diagnosis of air embolism was made on a rapid and progressive drop of FECO2 with, at the same time, a rise of the pulmonary arterial pressure.

Travail de nuit; migration et pression arterielle: une etude comparative sur un groupe d'Africains vivant a Yaounde

La pression arterielle d'un groupe de gardiens de nuit a ete comparee a celle d'un groupe de personnes de memes conditions socio-economiques mais travaillant exclusivement dans la journee. L'age des sujets variait de 20 a 49 ans avec une nette predominance des sujets ages de 20 a 29 ans. Les comparaisons ont aussi ete faites en tenant compte de la nationalite camerounaise ou non des sujets. Les gardiens de nuit en general et ceux de nationalite camerounaise en particulier avaient des pressions arterielles significativement plus elevees que celles des travailleurs de jour; cette difference persistait apres stratification de l'echantillon par age. En revanche; les etrangers n'avaient pas de pression arterielle plus elevee que celle des Camerounais; bien plus; le fait d'etre a la fois etranger au Cameroun et gardien de nuit n'a pas contribue a une elevation significative des pressions arterielles des pressions arterielles des etrangers comparees a celles des autres groupes