Diabetes Related Amputations in the North West Region of Cameroon

Objective: To identify cases of diabetic related amputation in the North West Region of Cameroon, determine the primary causes of amputation, assess the major determinants of the health problem, and propose recommendations to manage diabetic foot patients. Methods: Three health facilities (Bamenda Station Polyclinic, Bamenda Regional Hospital and Mbingo Baptist Hospital) were selected to participate in this retrospective study. Medical records of patients with diabetic related amputation or debridement were reviewed between January 2006 and June 2011. Age, gender, duration of hospitalization, diagnosis, procedures performed and mortality status were obtained from the 82 medical records selected for the study. Data were analyzed using the statistical toolbox in Ms EXCEL. Results: Most (66.2%) of the cases were adults above 51 years of age, the life expectancy of Cameroon. The age of the cases ranged from 21yrs to 90 yrs with an average of 57.8 ± 13.9 years. The male to female ratio was 1.5:1 and the duration of hospitalization ranged from 3 days to 154 days with the age group 50-59yrs producing a peak cumulative total of 1172 days of hospitalization. Amputation and debridement constituted 78% and 22% of the cases reviewed respectively. There were 14 deaths resulting from the amputation and the major diagnosis were necrosis, gangrene, ulcer, diabetic foot, ischemia, cellulitis and septicemia. Conclusion: Diabetic patients, if not properly monitored and cared for, can develop severe foot complications which can have adverse consequences such as amputation and debridement. With poverty and lack of education being the two major causes of late staged diagnosis of diabetic foot complications, government subsidized medical services and education campaigns are highly recommended.Master of Public Healt

Combined anterior cervical spine fusion and total laryngopharyngectomy with free flap reconstruction: A technical note

Background and importance: In complex cases such as dropped head cervical deformity due to post-radiation myopathy, anterior cervical discectomy and fusion (ACDF) could be done for deformity correction. In rare circumstances where there is a concurrent need for a total laryngopharyngectomy (TLP) and ACDF, there is a remarkable corridor for cervical discectomy and fusion from the extensive neck exposure. Clinical presentation: We present the case of a patient with history of primary oropharyngeal squamous cell carcinoma and left parotid carcinoma status post treatment, now with post-radiation laryngeal dysfunction and dropped head cervical spinal deformity. Patient underwent posterior fixation for deformity correction and also to create anterior access for total laryngopharyngectomy (TLP). He then underwent combined TLP with anterolateral thigh (ALT) free flap reconstruction and C3-5 ACDF with a vascularized pre-vertebral fascia flap coverage of the spinal hardware. Conclusion: This unique case report is the first of its kind where total laryngopharyngectomy with free flap reconstruction was performed together with an anterior cervical discectomy and fusion. Though complex, such procedures can be performed with satisfactory outcomes in well-established centers

Minimally Invasive Transforaminal Versus Direct Lateral Lumbar Interbody Fusion: Effect on Return to Work, Narcotic Use, and Quality of life

BACKGROUND: Direct lateral (DLIF) and transforaminal (TLIF) lumbar interbody fusions have been shown to produce satisfactory clinical outcomes with significant reduction in pain and functional disability. Despite their increasing use in complex spinal deformity surgeries, there is a paucity of data comparing outcome measures, which this study addresses. METHODS: This is a retrospective, comparative study of patients who underwent minimally invasive, 1-level TLIF or DLIF between 2013 and 2015. Only patients 18 years and older were included. Preoperative and demographic variables were collected, and clinical outcome measures were compared between cohorts. RESULTS: In total, 46 patients were included (DLIF: 17 patients; TLIF: 29 patients). Preoperatively, there was no difference in visual analog scale pain score or Oswestry Disability Index. Overall, there was a significant improvement in the postoperative visual analog scale score and Oswestry Disability Index in the separate cohorts, without significant difference when compared. The duration of postoperative narcotic use was similar in both cohorts (DLIF: 4.8 ± 4.7 months vs. TLIF: 5.2 ± 5.1 months, P = 0.82). Significantly more patients in DLIF cohort were cleared for work after surgery. Patients who underwent MIS TLIF had a significantly longer time to return to work (7.1 ± 4.8 months) compared with patients undergoing DLIF (2.3 ± 1.3, P = 0.006). There was a greater incidence of reoperation in the TLIF cohort. CONCLUSIONS: Both MIS TLIF and DLIF provide long-term improvement in pain andfunctional outcomes, with an overall reduction in postoperative narcotic requirement. However, there was a significantly longer time to return to work and a greater incidence of reoperation in the TLIF cohort compared with the patients who underwent DLIF

Effect of 6% hydroxyethyl starch 130/0.4 in 0.9% sodium chloride (Voluven®) on complications after subarachnoid hemorrhage: a retrospective analysis

10.1186/2193-1801-2-314SpringerPlus211-