Composite indices of upstream pulmonary vascular impedance and capacitance do not help in identifying patients who should undergo pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension

Background Chronic thromboembolic pulmonary hypertension (CTEPH) is potentially curable by surgical pulmonary endarterectomy (PEA). Patient selection for PEA is crucial and depends mainly on discriminating between those with proximal accessible disease and distal disease. In this study we evaluated the value of composite indices such as upstream resistance (Zup) and capacitance (Cp) for partitioning of pulmonary vascular resistance and surgical outcome. Methods We retrospectively reviewed data from 30 patients who underwent PEA between 2007 and 2012. Zup, defined as the ratio between the mean pulmonary artery pressure (PAPm) minus diastolic pulmonary artery pressure (PAPd) and PAPm minus pulmonary artery occlusion pressure (POAP), was computed preoperatively as was the Cp, defined as the ratio of stroke volume over pulse pressure. We assessed the use of these indices to predict pulmonary haemodynamics after PEA. Results Postoperatively, total pulmonary vascular resistance (tPVR) was > 400 dynes·s·cm-5 in 11 patients (37%); nine patients were treated with an endothelin receptor antagonist (ERA) and had unsatisfactory surgical results. Preoperative Cp was identical in both groups (0.9945 ± 0.06867 vs. 1.348 ± 0.1961, P = 0.14). Zup was higher in the group with better haemodynamic outcomes (50.29% ± 3.266) than in the ERA group (38.59% ± 2.86) (P < 0.05). In multivariate analysis, the relation of Zup and outcome was not statistically significant when adjusted for tPVR. Conclusions The composite indices Cp and Zup were not useful for distinguishing between CTEPH patients who were good candidates for PEA versus patients with substantial distal vasculopathy with PVR values that remained elevated after surgery.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Application of the Canadian C-Spine rule and nexus low criteria and results of cervical spine radiography in emergency condition

Introduction: the Canadian C Spine Rule (CCR) and the National Emergency X-Radiography Utilization Study (Nexus) low criteria are well accepted as guide to help physician in case of cervical blunt trauma. Methods: we aimed to evaluate retrospectively the application of these recommendations in our emergency department. Secondly we analyzed the quality of cervical spine radiography (CSR) in an emergency setting. Results: 281 patients with cervical blunt trauma were analyzed retrospectively. The CCR and the NEXUS rules were respected in 91.2% and 96.8% of cases respectively. No lesions were found in 96.4% of patient. A lesion was present in 1.1% of patient and suspected in 2.5% of patient. The quality of CSR was adequate in only 37.7% of patient. The poor quality of CSR was due either to the lack of C7 vertebrae visualization in 64.6% or other lower vertebrae in 28%. Other causes included the absence of open mouth view (8%), the absence C1 vertebrae visualization (3.4%), artifact in 2.3% and the absence of lateral view in 0.6% of patient. Conclusion: CCR and NEXUS are widely used in our emergency department. The high rate of inadequate CSR reinforces the debate about it’s utility in emergency condition

Hypoxemia after pneumothorax exsufflation: a case report

We describe a 36-year-old patient who was admitted to the emergency ward for acute dyspnea due to a spontaneous pneumothorax. He was successfully drained but shortly after presented a severe hypoxemia due to pulmonary oedema secondary to pulmonary re-expansion. The physiopathology behind this complication is still unknown. We will try to describe this complication and its predictive factors.Keywords: Pneumothorax, re-expansion, oedema, hypoxemi

Hypoxemia after pneumothorax exsufflation: A case report

We describe a 36-year-old patient who was admitted to the emergency ward for acute dyspnea due to a spontaneous pneumothorax. He was successfully drained but shortly after presented a severe hypoxemia due to pulmonary oedema secondary to pulmonary re-expansion. The physiopathology behind this complication is still unknown. We will try to describe this complication and its predictive factors.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Cardiac surgery in sub-Saharan Africa: a report of 3-year experience at the Douala General Hospital

Background: Cardiac surgery was started at the Douala General Hospital since 2012 as a result of a North-South collaboration between Cameroon and Belgium. Five cardiac surgery missions have been carried out since then. This work aimed at assessing three years of this initial experience. Methods: We carried out a cross-sectional descriptive study between November 2012 and March 2016. We reviewed the case records of all patients with heart disease, and with an indication for surgery. Results: A total of 45 patients with heart diseases who had an indication for surgery were retained for this study. There were 23 women and 22 men. Of these, 27 patients benefited from surgical intervention. Their mean age was 41±18 years (range, 14 to 85 years). The most common physical sign was heart murmur in 29 (64.4%) patients. Valvular Heart diseases were the most frequent in 32 (71.1%) patients, which were predominantly rheumatic heart diseases (RHD) in 25 (55.6%) patients. The most frequent surgical procedures were valve replacement with prosthesis, followed by repairs of congenital abnormalities. Mechanical prosthesis were mostly used (8/12 cases). Short-term intra-hospital mortality was 7.4%. The main cause of death was acute ventricular failure. Conclusions: The pilot phase of the cardiac surgery program at the General Hospital of Douala (DGH) was successful. Patients could be operated at a lower cost locally. Efforts must be made for the creation of an autonomous local team.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Late mortality after cardiac interventions over 10-year period in two Cameroonian government-owned hospitals

Background: Cardiac surgery is a growing activity in Sub-Saharan Africa, however, data related to long-term mortality are scarce. We aimed to analyze outcome data of cardiac interventions in two hospitals in Cameroon over 10 years' period. Methods: we conducted a retrospective analytical and descriptive study at the Douala General Hospital and Yaoundé General Hospital. All patients operated between January 2007 and December 2017, or their families were contacted by phone between January and April 2018 for a free of charges medical examination. Results: Of a total of 98 patients operated during the study period, 8 (8.2%) were lost to follow-up. Finally, 90 patients [49 (54.4%) women and 41 (45.6%)] men were included. The mean age was 49±22 years (range, 13-89 years). The surgical indications were valvular heart diseases in 37 (41.1%) cases, congenital heart diseases in 11 (12.2%) cases, chronic constrictive pericarditis in 4 (4.4%) cases, and intra cardiac tumor in 1 (1.1%) case. Valve replacement was the most common type of surgery carried out in 37 (41.1%) cases-mostly with mechanical prosthesis. Pacemaker-mostly dual-chambers were implanted in 36 (40.0%) patients. The median follow-up was 26 months. The overall late mortality was 5.7%, and the overall survival rates at 5 and 10 years were 95.5% and 94.4% respectively. The overall survival rates at 5 and 10 years for mechanical valve prosthesis were 93.3% and 90% respectively. The survival at 10 years was 100% for patients with bioprosthesis. The survival rates at 10 years were 94.1% and 100% respectively for dual and single chamber pacemaker. Conclusions: Long-term outcome of cardiac surgery in hospitals in Cameroon are acceptable with low mortality rate. However, outcome metrics beyond mortality should be implemented for a prospective data collection.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Outcome of permanent vascular access for haemodialysis in patients with end-stage renal disease in Cameroon: Results from the pilot experience of the Douala general hospital

Background: Chronic Kidney disease is a major health problem in the world. Native arteriovenous Fistula (AVF) is well established as the best vascular access for haemodialysis. Little is known about the outcome of AVF in sub-Saharan Africa. We aim to analyze the outcome of patients undergoing AVF creation during the pilot program established at the Douala general hospital (DGH). Method: This was hospital-based, longitudinal study with a retrospective phase (April 2010-January 2014) and a prospective phase (January 2014-April 2014). All consecutive patients operated for AVF creation were included in this study. Socio-demographics data, functionality, and complications were analyzed. Results: Eighty-one patients including 52 men were enrolled in this study (49 prospectively and 32 retrospectively). The mean age was 52, 3 years (range 18-81 years). Hypertension (66, 7%), diabetes (17, 3%), and HIV (8, 6%) were the most observed co-morbidities. About 96.3% of AVF were native and 3.7% were prosthetic graft. Radiocephalic AVF was performed at a rate of 77.8%. The primary function rate was 97.7% and the mean follow-up period 43.4 weeks. The overall rate of complications was 44.4% of whom 30.5% were early, 30.5% secondary, and 39% lasted. The treatment of these complications was conservative in 48.7% of cases. Conclusions: The results of the pilot program of AVF creation at the DGH are encouraging. However, the sustainability of this project requires human capacity building.SCOPUS: ar.jinfo:eu-repo/semantics/publishe