Omentoplasty as an effective surgical modality for managing a high risk patient with deep sternal wound infection

Poorly managed diabetes and hypertensives are risk factors for deep sternal wound infection (DSWI) following cardiac surgery; leading to increased morbidity and mortality. To reappraise the effectiveness of omental flap in the management of High risk patient with DSWI. A middle aged man with extensive mediastinitis following cardiac surgery (from outside referral). He was a known Diabetic and Hypertensive who was poorly compliant on medications. The history, physical examination, gycosylated Haemoglobin (HbA1c) and microbiological analyses showed high blood pressure, poor glycaemic control, septicaemia with staphylococcal DSWI. Resuscitation was achieved with the use of oral antihypertensives, Human insulin and antibiotics respectively. The DSWI was managed with serial debridement and subsequent wound cover with omental flap. The hospital stay was shorter and outcome was good. The management of DSWI with omental flap may be an effective surgical modality that reduces morbidity and mortality even in high risk patients

Recombinant-activated factor VII in the paediatric cardiac surgery: Single unit experience

Background: The control of excessive bleeding after paediatric cardiac surgery can be challenging. This may make the use of recombinant-activated factor VII (rFVIIa) in preventing this excessive bleeding, after adopted conventional methods have failed, desirable. Our aim is to  highlight our experience with the use of rFVIIa in preventing excessive bleeding after paediatric cardiac surgery.Patients and Methods: The data for 14 patients who had rFVIIa for excessive haemorrhage after cardiac surgery from December 2009 to November 2010 was analysed. The perioperative blood loss from the chest drain before and after the administration of rFVIIa, use of blood products, international normalized ratio (INR) and activated partial thromboplastin (aPTT), before and after administration of rFVIIa, were analysed.Results: The rFVIIa was successful in stopping bleeding in all the patients. The mean coagulation factors before rFVIIa were as follows: INR, 2.88 (1.82–4.5); aPTT, 65 seconds (33.4–95.1); after rFVIIa, the mean INRwas 1.2 (0.82–1.56), mean APTT was 38.7 seconds (25.6–54.9). No  thromboembolic events or allergic reactions or deaths were recorded. Conclusions: rFVIIa use is not only effective in stopping excessive perioperative bleeding but also safe and indirectly reduces transfusion of blood and its products. Key words: Coagulating factor, excessive bleeding, paediatric cardiac surgery, recombinant-activated factor VI

Superior repair: A useful approach for some anatomic variants of total anomalous pulmonary venous connection

Background: Total anomalous pulmonary venous connection (TAPVC) occurs when all the four pulmonary veins drain to the right atrium or to tributaries of the systemic veins. There have been various published techniques for the repair but none has been agreed on for the different anatomical variants that may be encountered during surgery.Patients and Methods: Between January 2005 and June 2010 the data of 6 of 18 patients who had surgical repair using the superior approach wereretrospectively reviewed.Three patients had long narrow venous stalk connecting the coronary sinus to venous confl uence; two had the right  pulmonary veins draining to superior vena cava (SVC) and left pulmonary veins to left lateral wall of SVC and one had an obstruction at entrance of Pulmonary Vein into venous confl uence. Results: Five patients initially had the superior approach while one had transatrial with unroofi ng of the coronary sinus. Two had a concomitant Wardens procedure. The mean aortic cross clamping was 87.5 (60-125) min, the mean cardiopulmonary bypass time should have min as unit of 127.8 (100-180), the mean Intensive Care Unit (ICU) stay of 2.5 (2-4)  days and the mean hospital stay 8.2 (7-9) days. One patient died at earlypost-operation from low cardiac outputand five had an uneventful  post-operative course and had remained stable until date.Conclusion: In our experience, the superior approach was an effective alternative approach for some anatomic variants of TAPVC that may be unexpectedly encountered during operation and also useful surgical  approach for older children.Key words: Long venous stalk, pulmonary venous obstruction, superior approach, trans-atrial approach, warden’s procedur

Multi-center survey of House officers’ choice of Medical specialties in Nigeria: preferences and determining factors

The objective of the study was to determine preferences and factors influencing the choice of medical specialties by House officers.  Questionnaires were distributed to House-officers in 4 tertiary hospitals namely: the National hospital, Abuja, the University of Port-Harcourt, the Jos University, and the University of Uyo Teaching Hospitals. The data were simultaneously collected and analyzed using SPSS 20.0 version. Of the 150 questionnaires distributed, 129(86%) were duly filled. The mean age was 22.4 years (range 21-40 years), 79(61.2 %) of the respondent were male. Fifty-nine(45.7%) chose training within the country while 32(24.8%)  preferred outside as 107(86%) chose training in Teaching Hospitals. Teachers, Resident doctors and parents influenced choices in 34(26.3%), 17(13.1%) and 16(12.4%) respectively. Thirty-four(26.3%), 28 (21.7%), 13(10.1%) and 15(11.6%) preferred obstetrics, surgery, internal medicine and paediatrics respectively. Seventy (46.7%) chose specialties for personal likeness and 17(11.3%) for role models in that specialty. House officers preferred to pursue medical specialty in teaching hospitals within the country and they are motivated by personal fulfilment, independence of practice and role models while more prefer to specialize in more Obstetrics/ Gyaenocology and surgery

Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study

Background: No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer.Method: This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III-V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%).Results: Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to HIC.Conclusion: Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer. (C) 2020 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved