9 research outputs found
Double half-cone flap umbilicoplasty for proboscoid umbilical hernia in a 2 years old child with satisfactory results 2 years later
Surgical repair of large umbilical hernias may present a challenging surgical problem; standard surgical techniques have proven to be inadequate for both closing the fascial defect of the umbilicus and providing a satisfactory cosmetic result. We describe here a case of double half-cone flap umbilicoplasty that was performed in a 2 years old boy. The case of a 2 years old child with proboscoid umbilical hernia. The protruding umbilical skin was excised sharply by two V-shaped cuts leaving two half cones, a short cephalic (0.5cm) and a long caudal (1cm). A classic herniotomy was carried out, with repair of the facial defect. The caudal half cone was sutured from its apex till half it's length upon itself with interrupted sutures and it was anchored deeply to the fascia. Then we inverted the cephalic half cone which was sutured to the caudal cone to form the new umbilicus. The early result was excellent with no complications and the result after 2years revealed a cosmetically satisfactory shape of the umbilicus. this technique provides a good solution for reconstruction of the protruding umbilical skin and it is easy to learn, easy to be taught and perform in surgical environments and may be applicable for any kind of umbilical reconstruction.Key words: Double half-cone flap, proboscoid umbilical hernia, umbilicoplast
Successful management of oesophageal atresia in Cameroon, Sub-Saharan Africa
Background: Oesophageal atresia (EA) is the most common congenital anomaly of the oesophagus. Despite improvement of survival observed over the previous two decades in developed countries, the mortality remains very high and the management greatly challenging in resource-poor settings such as Cameroon. We report our experience of management of EA in this environment, with a successful outcome. Materials and Methods: We prospectively assessed patients diagnosed with EA and operated in January 2019, at the University Hospital Centre of Yaounde. Records were reviewed for demographics, history and physical examinations, radiological findings, surgical procedures and outcomes. The study has received approval from the Institutional Ethics Committees. Results: In total, six patients (three males and three females, sex ratio, 0.5; mean age at diagnosis, 3.6 days; range, 1–7 days) were assessed. A past history of polyhydramnios was found in one patient (16.7%). All patients were classified Waterston Group A at diagnosis, with Ladd-Swenson type III atresia. Early primary repair was performed in four patients (66.7%) and delayed primary repair in two patients (33.3%). Operative repair mainly involved resection of the fistula, suture of trachea and oesophagus end-to-end anastomosis, followed by interposition of vascularised pleural flap. Patients were followed up 24 months. With one late death, the survival rate was 83.3%. Conclusion: Improvement has been achieved in the outcomes of neonatal surgery in Africa in the past two decades, but EA-related mortality remains relatively too high. Using simple techniques and available, reproducible equipment can improve survival in resource-poor settings
Complex Pulmonary Aspergilloma: Surgical Challenges in a Third World Setting
Background. Surgery for pulmonary aspergilloma (PA), especially complex forms, is greatly challenging in a resource-poor setting such as Cameroon. We report our experience of surgical management of PA in this environment. Method. We prospectively assessed patients who underwent surgery for PA from January 2012 to May 2015, at the University Hospital Center of Yaoundé. Records were reviewed for demographics, history and physical examinations, radiological findings, surgical procedures, and outcomes. The study has received approval from the institutional ethics committees. Results. In total, 20 patients (17 males and 3 females (sex ratio, 5.66); mean age, 30 years; range, 23–65 years) with a past history of tuberculosis were assessed. The median follow-up was 21.5 months. The primary symptom was hemoptysis, followed by cough and chest pain. All patients underwent surgical treatment and lung resection. Postoperative complications (bleeding, air leak, empyema, and severe anemia) occurred in 4 patients and 1 patient died. Although 3 patients were lost to follow-up, the survival rate was 80% with improvement of the preoperative symptoms. Conclusion. Although surgery for complex aspergilloma is very challenging in environments such as ours, we believe that it is the best treatment modality for symptomatic diseases in our setting
Vascular hyperreactivity in black Cameroonian hypertensive and normotensive patients: A comparative study
Introduction: Vascular hyperreactivity is a risk factor and a factor predicting hypertension (high blood pressure). Unlike other continents where several studies were carried out, it has rarely been studied in black Africa in general and in Cameroon in particular.Methods: Vascular reactivity was measured by the cold test. Vascular hyperreactivity was defined as an increase in blood pressure > 20 mmHg for systolic and/or > 15 mmHg for diastolic. Khi2, Man-Withney, Wilcoxon's signed ranks and logistic regression tests were used for statistical analysis.Results: A total of 31 hypertensive and 31 normotensive patients matched by age and sex participated in this study. Vascular hyperreactivity was present in 77.4%hypertensive patients and 51.6% normotensive patients. There was a significant association between vascular hyperreactivity and hypertension [OR = 3.2 (1.07 - 9.63), p = 0.034]. The median arterial pressure was higher in responders compared to non-responders in the normotensive group. Age > 45 years, female sex, obesity and family history of hypertension appeared to be associated with vascular hyperreactivity, but only in normotensive patients.Conclusion: Vascular hyperreactivity appears to be a risk factor for high blood pressure in black Cameroonians. Itappeared to be associated with low blood pressure, age, sex, obesity and family history of hypertension but this was only in the normotensive. Key words: Vascular hyperreactivity, high blood pressure, black Cameroonian, cold tes
Unusual Life-Threatening Pneumothorax Complicating a Ruptured Complex Aspergilloma in an Immunocompetent Patient in Cameroon
An aspergilloma is a well-recognized lesion of the lung caused most of the time by the fungus Aspergillus fumigatus. Its main complication is hemoptysis and has been very rarely associated with tension pneumothorax. We present the case of a 47-year-old man with a history of treated and healed tuberculosis, which was successfully managed in our service for a ruptured right upper lobe complexed aspergilloma, complicated by a massive and tension pneumothorax. The patient underwent thoracotomy and lung resection with quick recovery. Conclusively, although rare, an aspergilloma may rupture and cause a life-threatening air leakage
Anesthésie pour chirurgie du rachis à l’hôpital d’instruction des armées de Yaoundé.
La chirurgie du rachis regroupe des interventions mineures et des interventions majeures. Le but de notre étude était de décrire les particularités liées à la pratique l’anesthésie pour la chirurgie du rachis dans notre contexte. Il s’agissait d’une étude descriptive et prospective sur une durée d’un an portant sur la chirurgie du rachis. Les variables étudiées étaient les aspects épidémiologiques, cliniques et topographiques des patients opérés pour chirurgie du rachis à l’HMR1 durant la période d’étude. La taille de l’échantillon était de 47 patients. Le sexe masculin était majoritaire avec 34 patients (72,3%) avec un sex-ratio de 2,61. L’âge moyen était de 46,53±15,89 ans. Les positions opératoires étaient la position genu pectoral (n=6, 12,8%), le décubitus dorsal (n=11, 23,4%) et le décubitus ventral (n=30, 63,8%). Concernant la classe ASA, 59,6% (n=28) des patients étaient ASA 1 et 40,4% (n=19) étaient ASA 2. Le saignement moyen était de 517,02±196,78 ml. La durée moyenne de la chirurgie était de 168,68±77,27 minutes. Les indications de chirurgie du rachis sont variées. Les impératifs de l’anesthésie sont liés à la technique chirurgicale, la position du patient et la gestion du saignement.
English Summary
Spine surgery implies minor and major intervention. The aim of our study was to describe the specific aspects related to the practice of anesthesia for spinal surgery in our context. It was a descriptive and prospective study cartied over a year for all cases of spine surgery. The variables studied were the epidemiological, clinical and topographical aspects of patients operated for spine surgery at the military hospital during the study period. Fourty-seven patients were included with a male predominace notably 34 patients (72.3%) and a sex ratio of 2.61. The mean age was 46.53±15.89 years. The petients installation included genupectoral position(n=6, 12.8%), supine position (n=11, 23.4%) and prone position (n=30, 63.8%). Concerning the ASA classification, 59.6% (n=28) of patients were ASA 1 and 40.4%(n=19) were ASA 2. The average blood loss was 517.02±196.78 ml. The average time of surgery was 168.68±77.27 minutes. The indications of spine surgery are diverse. Anesthesia must be adapted considering key aspects such as the surgical technique, patient position and bleeding management.
Keywords: anesthesia, spine surgery, military hospital, Yaoundé
Anesthésie pour tumeurs cérébrales opérées à l’hôpital d’instruction des armées de Yaoundé.
L’anesthésie pour la chirurgie des tumeurs cérébrales impose de respecter de nombreux impératifs. L’objectif de notre étude était de répertorier les aspects épidémiologiques, cliniques et thérapeutiques de la prise en charge des tumeurs cérébrales. Notre avons mené une étude analytique et prospective des patients opérés à l’hôpital d’instruction des armées pour tumeur cérébrale Durant la période de Février 2021 à Février 2022. Ont été inclus dans notre étude tous les patients consentants reçus au service des urgences ou en neurochirurgie avec un diagnostic de tumeur cérébrale à l’imagerie. Les variables étudiées chez les patients étaient : les caractéristiques épidémiologiques; les aspects cliniques et paracliniques des lésions si la biopsie avait été réalisée ; les données cliniques et paracliniques en péri-opératoire. Les données ont été recueillies sur une fiche d’enquête. La saisie et l’analyse des données ont été faites grâce au logiciel Epi info version 3.5.4 et Excel 2013. Dix-neuf patients ont été colligés dans notre étude. Le sexe féminin était majoritaire avec 12 (63,15%) contre 7 (36,8%) patients de sex maxculin, soit un sex ratio de 0,58. L’âge moyen était de 49,3±15,23 ans. Concernant le type de tumeur, 15(78,94%) patients avaient un méningiome, 3(15,78%) étaient opérés pour adénome de l’hypophyse et 01(5,26%) patient présentait une malformation de Chiari. Lors de l’évaluation du risque anesthésique classe ASA, (21,1%) patients étaient classés ASA 1, 13(73,7%) étaient ASA 2 et un patient était ASA 3. Le méningiome était la tumeur la plus hémorragique avec une Moyenne de 1404,16±567,47 ml (p=0,03). La durée moyenne de la chirurgie était de 333,63 ± 116,15 minutes contre 381,84±121,48 minutes pour l’anesthésie. Le taux de mortalité à 72H était de 10,5%. L’anesthésie pour tumeur cérébrale repose sur des impératifs qui passent par la bonne preparation du malade à la chirurgie, la maîtrise des spécificités propres à la chirurgie de chaque type de tumeur et le bon choix des médicaments.
English Summary
requires respecting many rules. The aim of our study was to determine the epidemiological, clinical and therapeutics aspects of the management brain tumors. We conducted an analytical, prospective study on patients operated for brain tumors at the Yaoundé military hospital from February 2021 to February 2022. Were included in our study all patients received in the emergency department or in neuro-surgery with a brain tumor diagnosed by imaging, who gave their consent. The variables studied were: the epidemiological characteristics, the clinical and paraclinical aspects of lesions
if the biopsy had been performed; the clinical and paraclinical perioperative data. The data was collected on a data sheet. Data entry and analysis were done using Epi info version 3.5.4 and Excel 2013. Nineteen patients were recruited in our study. The female sex was predominant with 12 patients (63.15%) versus 7 (36.8%) males giving a sex ratio of 0.58. The mean age was 49.3±15.23 years. Regarding the type of tumor, 15 (78.94%) patients had a meningioma, 3 (15.78%) had a pituitary adenoma and 1 (5.26%) patient presented with Chiari's malformation. When assessing the anesthetic risk by the ASA classification, 21.1%patients were classified as ASA 1, 13 (73.7%) were ASA 2 and one patient was ASA 3. Meningioma was the most hemorrhagic tumor with an average blood loss of 1404.16±567.47 ml (p=0.03). The average time of surgery was 333.63 ± 116.15 minutes against 381.84±121.48 minutes for anesthesia. The mortality rate at 72 hours was 10.5%. Brain tumor anesthesia is based on imperatives from the right preparation of the patient for surgery, control of specificities related to the surgery of each type of tumor and the right choice of drugs.
Keywords: anesthesia, brain tumors, military hospital, Yaounde