Patent Ductus Arteriosus in Adults: Surgical Experience in Ivory-Coast

Background: Patent ductus arteriosus surgery is well documented. Hospital Mortality has reduced to almost 0%. Yet, with adults, this surgical cure is likely to be difficult and require some technical skills Method: A retrospective study of surgical procedures and results after surgery of patent ductus arteriosus (PDA) in adults. Results: Since 1978 to 2000 we have reported 16 operated cases. The average age was 22.5 years. There was female predominance with a sex ratio of 2.3/1. All patent ductus arteriosus had been confirmed by two dimensional echocardiography (2D echocardiography) and cardiac catheterization. All hemodynamic types of Nadas classification were observed. Double or triple ligation supported on Teflon felt was the most frequent technique used (69%). This technique gave good results in view of the absence of hospital mortality and only 1 case of recanalisation after a long follow up of all patients from 1 - 7 years (mean 5 years). Conclusion: Double or triple ligation on Teflon felt according to Wright technique is a good technique.Introduction: La chirurgie persistance du canal art\ue9riel est bien codifi\ue9e. Mortalit\ue9 hospitali\ue8re devient plus inf\ue9rieure ou presque 0%. N\ue9anmoins, chez des adultes, ce rem\ue8de chirurgicale parait \ueatre difficile et demande quelque connaissance technique. M\ue9thode: Le but de cette \ue9tude r\ue9trospective est d'analyser notre attitude chirurgicale et nos r\ue9sultats au cours de la chirurgie de la persistance du canal art\ue9riel (PCA) chez l'adulte. R\ue9sultats: De 1978 \ue0 2000, nous avons collig\ue9 16 cas op\ue9r\ue9s. L'\ue2ge moyen \ue9taitt de 22.5 ans. Il y a une pr\ue9dominance f\ue9minine avec un sex ratio de 1.6/1. Chez tous les patients, la PCA a \ue9t\ue9 confirm\ue9e par l'\ue9chocardiographie bidimensionnelle et le cath\ue9t\ue9risme cardiaque droit. Tous les types h\ue9modynamiques de la classification de Nadas \ue9taient retrouv\ue9es. La double ou triple ligature appuy\ue9e sur bandelette de T\ue9flon a \ue9t\ue9 le proc\ue9d\ue9 technique le plus souvent ex\ue9cut\ue9 (69% des cas). Cette m\ue9thode chirurgicale ne nous a apport\ue9 des r\ue9sultats satisfaisants avec une mortalit\ue9 op\ue9ratoire nulle, 1 cas de reperm\ue9abilisation imm\ue9diate corrig\ue9e avec succ\ue8s et une absence de reperm\ue9abilisation du canal art\ue9riel \ue0 long terme apr\ue8s un suivi moyen de 5 ans (extr\ueames 1 \ue0 7ans) de tous nos patients. Conclusion: Au vu de notre exp\ue9rience, la double ou triple ligature sur bandelette de T\ue9flon selon Wright peut s'envisager efficacement dans la cure chirurgicale de la PCA de l'adulte

Arterial trauma of the extremities. An Ivorian surgical experience(Côte d’Ivoire)

Objective: The goal of this retrospective study is to present our epidemiological , clinical and surgical experience of the arterial injuries of extremities for 23 years(1977 to 2000).Materials and Methods: 35 patients were operated on over the study period. Their case files have been reviewed and forms the subject of this studyResults: 30 were men and 5 women with an age range of 14 months - 63 years and a median age of 25.4 years. The etiology of these injuries were side-arms(n=15), fire arms (n=5) , road or work accident (n=6) and iatrogenic (n=9 ). The injured arteries were: the femoral artery 18 , the popliteal artery 2 , the subclavian artery 2 the axillary artery 1 , the brachial artery 10 , the ulnar artery 1 ,the radial artery 1patient . Complete arterial rupture was the most frequent lesion n = 14. An incomplete arterial rupture was noted in 6 patients , and arterial thrombosis 6, a thrombosis coexisting with an intima damage in 1 case, and avulsion in 1, an arteriovenous fistula (n = 3) and a false aneurysm (n = 3). Adjacent Injuries were encountered :Bone fractures (n = 9), muscle tear (n = 10), nerve section(n = 12), vein section (n = 11), tendon section (n = 1), and haemothorax (n = 1) . Clinically most patients presented with complete or partial limb ischemia (28 patients). The arterial repair was by end to end anastomosis with saphenous vein (8 patients), or without graft (5 patients), lateral suture (8 patients), arterial clot extraction by balloon catheter (8 patients), direct vessel suture via longitudinal venotomy (2 patient) or arterotomy (1 patient), an aneurysmectomy 1 case. In one patient the limb was amputated because arterial repair was not possible; . There two 2 operative deathsdue to reperfusion injury (1 case) and biliary peritonitis(1 case).ConclusionArterial injury is a true surgical emergencies and repair should be urgent to avoid limb loss and even death

Bilateral Endomyocardial Fibrosis In Children: An Ivorian Surgical Experience

The aim of this study was to identify the clinical features and the risk factors for mortality in children who had surgery for bilateral endomyocardial fibrosis. (EMF). Consecutive children who had surgery for bilateral endomyocardial fibrosis in Institute of cardiology of Abidjan from 1978 to 2003 were retrospectively reviewed. There were 34 patients, 18 (52.9%) were boys and 16 (47.1%)were girls (M: F=1.3:1).Their ages ranged from7 to 15 years (mean, 11 years). All the patients had tricuspid andmitral regurgitation and severe chronic systemic venous congestion with low cardiac output. The left sided form was predominant in 21 (61.8%) patients, and the right sided form in 16(47.1%). Surgery consisted of ventricular endocardectomy with either mitral and/or tricuspid valve reconstructive procedures in 14 (41.2%) patients and valvular replacement in 29 (85.3%). There were 10 (29.4%) hospital deathsmainly due to lowcardiac output. Bilateral EMF is associated with high hospital mortality. Routine parenteral administration of inotropic drugs at the end of the cardiopulmonary by-pass in theatre and maintaining them in intensive cares unit satisfactory haemodynamic stabilization is advised. Keywords: Endomyocardial fibrosis, Surgery. African Journal of Paediatric Surgery Vol. 4 (2) 2007: pp. 64-6

Patent Ductus Arteriosus in Adults: Surgical Experience in Ivory-Coast

Background: Patent ductus arteriosus surgery is well documented. Hospital Mortality has reduced to almost 0%. Yet, with adults, this surgical cure is likely to be difficult and require some technical skills Method: A retrospective study of surgical procedures and results after surgery of patent ductus arteriosus (PDA) in adults. Results: Since 1978 to 2000 we have reported 16 operated cases. The average age was 22.5 years. There was female predominance with a sex ratio of 2.3/1. All patent ductus arteriosus had been confirmed by two dimensional echocardiography (2D echocardiography) and cardiac catheterization. All hemodynamic types of Nadas classification were observed. Double or triple ligation supported on Teflon felt was the most frequent technique used (69%). This technique gave good results in view of the absence of hospital mortality and only 1 case of recanalisation after a long follow up of all patients from 1 - 7 years (mean 5 years). Conclusion: Double or triple ligation on Teflon felt according to Wright technique is a good technique.Introduction: La chirurgie persistance du canal artériel est bien codifiée. Mortalité hospitalière devient plus inférieure ou presque 0%. Néanmoins, chez des adultes, ce remède chirurgicale parait être difficile et demande quelque connaissance technique. Méthode: Le but de cette étude rétrospective est d'analyser notre attitude chirurgicale et nos résultats au cours de la chirurgie de la persistance du canal artériel (PCA) chez l'adulte. Résultats: De 1978 à 2000, nous avons colligé 16 cas opérés. L'âge moyen étaitt de 22.5 ans. Il y a une prédominance féminine avec un sex ratio de 1.6/1. Chez tous les patients, la PCA a été confirmée par l'échocardiographie bidimensionnelle et le cathétérisme cardiaque droit. Tous les types hémodynamiques de la classification de Nadas étaient retrouvées. La double ou triple ligature appuyée sur bandelette de Téflon a été le procédé technique le plus souvent exécuté (69% des cas). Cette méthode chirurgicale ne nous a apporté des résultats satisfaisants avec une mortalité opératoire nulle, 1 cas de reperméabilisation immédiate corrigée avec succès et une absence de reperméabilisation du canal artériel à long terme après un suivi moyen de 5 ans (extrêmes 1 à 7ans) de tous nos patients. Conclusion: Au vu de notre expérience, la double ou triple ligature sur bandelette de Téflon selon Wright peut s'envisager efficacement dans la cure chirurgicale de la PCA de l'adulte

Arterial trauma of the extremities. An Ivorian surgical experience(Côte d’Ivoire)

Objective: The goal of this retrospective study is to present our epidemiological , clinical and surgical experience of the arterial injuries of extremities for 23 years(1977 to 2000). Materials and Methods: 35 patients were operated on over the study period. Their case files have been reviewed and forms the subject of this study Results: 30 were men and 5 women with an age range of 14 months - 63 years and a median age of 25.4 years. The etiology of these injuries were side-arms(n=15), fire arms (n=5) , road or work accident (n=6) and iatrogenic (n=9 ). The injured arteries were: the femoral artery 18 , the popliteal artery 2 , the subclavian artery 2 the axillary artery 1 , the brachial artery 10 , the ulnar artery 1 ,the radial artery 1patient . Complete arterial rupture was the most frequent lesion n = 14. An incomplete arterial rupture was noted in 6 patients , and arterial thrombosis 6, a thrombosis coexisting with an intima damage in 1 case, and avulsion in 1, an arteriovenous fistula (n = 3) and a false aneurysm (n = 3). Adjacent Injuries were encountered :Bone fractures (n = 9), muscle tear (n = 10), nerve section(n = 12), vein section (n = 11), tendon section (n = 1), and haemothorax (n = 1) . Clinically most patients presented with complete or partial limb ischemia (28 patients). The arterial repair was by end to end anastomosis with saphenous vein (8 patients), or without graft (5 patients), lateral suture (8 patients), arterial clot extraction by balloon catheter (8 patients), direct vessel suture via longitudinal venotomy (2 patient) or arterotomy (1 patient), an aneurysmectomy 1 case. In one patient the limb was amputated because arterial repair was not possible; . There two 2 operative deaths due to reperfusion injury (1 case) and biliary peritonitis(1 case). Conclusion: Arterial injury is a true surgical emergencies and repair should be urgent to avoid limb loss and even death

Percepção materna da desidratação em crianças com diarréia: estudo de concordância com diagnóstico médico Maternal perception of dehydration in children with diarrhoea: a study of agreement with medical diagnosis

Realizou-se estudo em um hospital infantil do Rio de Janeiro, em crianças hospitalizadas por diarréia, no período de janeiro/87 a fevereiro/88, com o objetivo de destacar a percepção materna dos sinais e sintomas da desidratação em crianças menores de três anos de idade, confrontando-a com o diagnóstico médico. Os sinais e sintomas mais identificados pelas mães foram o número de evacuações, número de vômitos, estado da sede e dos olhos. As mães tiveram dificuldade em perceber a quantidade de urina, o estado de umidade da boca e língua e turgor da pele. Identificaram estes sinais quase sempre como normais ou no máximo, moderadamente alterados. As mães que tenderam a subestimar a gravidade da desidratação apontada pelo médico tem nível de escolaridade baixo, filhos desnutridos e maior dificuldade de acesso ao hospital. Já as que tenderam a superestimar a gravidade, têm melhor nível de instrução, filhos melhor nutridos, maior facilidade de acesso ao hospital, bem como passaram por um menor número de serviços de saúde antes de chegar ao hospital estudado. As mães que concordaram com o diagnóstico médico classificaram-se em uma situação intermediária, embora se aproximando mais das que subestimaram a gravidade. Aquelas mães que já haviam vivenciado um episódio de desidratação anterior no seu filho não apresentaram maior concordância com o diagnóstico do médico, mostrando que o repasse de informação no serviço de saúde foi nulo ou inadequado.<br>The mother's perception of signs and symptoms of dehydration in children under three years of age was studied and compared with the medical classification. The study was carried out in a children's hospital in the city of Rio de Janeiro, among children hospitalized with diarrhoea between January, 1987 and February, 1988. The number of excretions and of vomitings, thirst and condition of eyes constituted the signs and symptoms most frequently reported by mothers. However, they had difficulty in judging the amount of urine, humidity of mouth and tongue and turgidity of the skin. These signs were almost always regarded as normal or, at most, as indicating only slight alteration. Those mothers who tended to underestimate the severity of the dehydration indicated by the physician were of a lower educational level and had more severely undernourished children and greater difficulty of access to the hospital. On the other hand, those who tended to overestimate it belonged to a higher educational level, had better-nourished children, greater ease of access to the hospital and were attended to by a smaller number of health care services before reaching the hospital surveyed. Those who agreed with the medical diagnosis were in ,an intermediate situation, although they tended to be closer to those who underestimated the gravity of the dehydration. Those mothers whose children had already gone through a dehydration episode did not present a more intense agreement with the physician's diagnosis, thus evidencing that the information afforded at the health care service was either non-existent or inadequate

The improvement of care for paediatric and congenital cardiac disease across the World: a challenge for the World Society for Pediatric and Congenital Heart Surgery

The diagnosis and treatment for paediatric and congenital cardiac disease has undergone remarkable progress over the last 60 years. Unfortunately, this progress has been largely limited to the developed world. Yet every year approximately 90% of the more than 1,000,000 children who are born with congenital cardiac disease across the world receive either suboptimal care or are totally denied care.While in the developed world the focus has changed from an effort to decrease post-operative mortality to now improving quality of life and decreasing morbidity, which is the focus of this Supplement, the rest of the world still needs to develop basic access to congenital cardiac care. The World Society for Pediatric and Congenital Heart Surgery [http://www.wspchs.org/] was established in 2006. The Vision of the World Society is that every child born anywhere in the world with a congenital heart defect should have access to appropriate medical and surgical care. The Mission of the World Society is to promote the highest quality comprehensive care to all patients with pediatric and/or congenital heart disease, from the fetus to the adult, regardless of the patient's economic means, with emphasis on excellence in education, research and community service.We present in this article an overview of the epidemiology of congenital cardiac disease, the current and future challenges to improve care in the developed and developing world, the impact of the globalization of cardiac surgery, and the role that the World Society should play. The World Society for Pediatric and Congenital Heart Surgery is in a unique position to influence and truly improve the global care of children and adults with congenital cardiac disease throughout the world [http://www.wspchs.org/]