Chewing gum reduces postoperative ileus after open appendectomy.

HYPOTHESIS: It is suggested that chewing gum may accelerate postoperative intestinal transit recovery. Chewing gum may therefore produce the same result after open appendectomy. DESIGN AND SETTING: Prospective, randomized study in a University teaching hospital. PATIENTS: 46 patients operated on by open appendectomy due to acute catarrhal appendicitis, appendicular abscess and appendicular generalized peritonitis. MAIN OUTCOME MEASURES: Interest was in occurrence of first flatus, first bowel movement, hospital duration and complications. RESULTS: A total of 46 patients were randomly divided into two groups: a chewing gum group (n=23) and a control group (n=23). In the first group, patients chewed sugarless gum for 30 minutes thrice daily until resumption of intestinal transit. Patient demographics, intra-operative, and postoperative care were the same for both groups. Chewing gum was well tolerated by all the patients. The first passage of flatus occurred on postoperative day 2.2 in the gum-chewing group and on day 3.0 in the control group (P < 0.0001). The first bowel movement occurred at postoperative day 2.3 in the chewing gum group and at postoperative day 3.3 in the control group (P < 0.0001). Five complications were noted overall. Hospital stay was shorter in the chewing gum group (4.9 days.) than in the control group (6.7 days), (P < 0.0001). CONCLUSION: Chewing gum ameliorates recovery after open appendectomy by reducing postoperative ileus. It is a cheap and helpful treatment to be recommended in developing countries in Africa.

[Current clinical features of acute appendicitis in adult in Yaounde, Cameroon]. / Aspects cliniques actuels des appendicites aiguës de l'adulte à Yaoundé, Cameroun.

Our study on acute appendicitis in adults aimed to report current data in Yaounde, Cameroon. This retrospective study included 323 patients, with 185 men against 138 women (sex ratio: 1.37). Mean age was 28.3 years old. Incidence was of 4.6%. Symptoms appeared within a delay of 3 to 4 days and consisted of the triad: abdominal pain (97.5%), vomiting (44%) and anorexia (39.9%). 99.7% of the patients presented with hyperthermia whereas defence on palpation in the right iliac fossa was noted in 307 patients. Rectal examination was evocative in 92.7% of the cases. Hypemeutrophilia was found in 84.9% of the patients. Plain abdominal radiography (PAR) orientated the diagnosis in 74.3% of cases; echography was very useful in abscesses (6,5%). 96.7% of the patients underwent surgery within an average time of 48 hours. McBurney incision was performed in 232 cases. Appendice in the inner latero caecal position was predominant in 243 cases. In seven cases (2.2%), appendice was normal; 2 Meckel's diverticula were discovered (0.6%). We carried out 309 anterograde appendectomies, 317 irvaginations of the appendicular root and 14 epiplooplasties. 302 histological exams were performed; catarrhal appendicitis were ranking first: 167 cases. Morbidity reached 14.2% dominated by sepsis (71.7%). The mortality rate was 0.6%. A better diagnostic approach together with a better sensitisation of the population may shorten surgical delays inducing a decrease of morbidity of acute appendicitis in Cameroon.

[Current problems of rehabilitating the handicapped in childhood]. / Attuali problematiche di riabilitazione dei portatori di handicap in età evolutiva.

An overview of current problems is accompanied by a clarification of the concepts underlying the terms "handicapped" and "rehabilitation". The main lines of intervention in the rehabilitation of handicapped subjects during the age of growth are explained, with reference to the essential matters involved in diagnosis, organisational structures, rehabilitation methods, and the comprehensiveness of treatment, education and rehabilitation. Conclusions are drawn in connection with the problems still widely discussed in this period, described - for this very reason - a period of reflection and transition. Lastly, note is taken of the many difficulties that impede the solutions, emphasis being placed on the need to sensitize society and coinvolve not only the operators and members of the family, but also all citizens. Sensitisation and involvement of this kind require reciprocal integration between the structures, and control of their planning, establishment in structures, and management at the territory levels.

[Functional re-education in various types of respiratory insufficiency]. / La rieducazione funzionale dei vari tipi di insufficienza respiratoria

The kinesitherapeutic and functional re-educational approach is indicated for each type of respiratory insufficiency, special attention being paid to those syndromes and diseases most frequently encountered in clinical practice. In the case of these (asthma, mucoviscidosis, emphysema, bronchorrhoea), the essential phases of kinesitherapy and re-education are outlined in greater detail. Clinically and psychologically, the conclusions sum up the attitude which should be assumed by the attending staff in cases of patients with respiratory insufficiency. Finally, the importance of physiopathological and clinical data and physiokinesitherapeutic experience are recalled.

[Maple syrup disease. A clinical and rehabilitative study]. / Malattia dello sciroppo d'acero. Contributo clinico-riabilitativo.

A child found, following long-drawn-out diagnosis, to be suffering from a disease characterised by maple syrup odour of the urine, offers the basis for some remarks on the most topical problems of rehabilitation in patients suffering from the sequelae of infant encephalopathies. The current physiopathologico-biochemical classification of protein metabolism changes and the nosographic-pathogenetic classification of the disease observed are reviewed. Mention is then made of diagnostico-clinical, laboratory and instrumental procedures before moving on to detailed description on the patient. Various re-educational techniques are examined and the paper closes with some remarks on problems of acceptance by society in the current socio-welfare-medical-educational situation. Stress is laid on the importance of attentive, profound analysis of each case, an examination which must exclude any mystifying equalitarianism a priori, and take the material form of effective intervention. Allowance must be made for the "globality" of the problems involved, the rejection of any "delegation", accompanied by a real awareness of the most appropriate solutions and the effective participation of the community as a whole. To achieve these aims, local medical structures today are of vital practical importance, representing as they do the analytical and operative terrain of afferences and efferences, precisely as regards their sociomedical-educational integration with specialist centres.

[Gastroesophageal reflux: diagnostic and therapeutic approach in tropical regions. Apropos of 33 case reports]. / Reflux gastro-oesophagien: approche diagnostique et thérapeutique en milieu tropical. A propos de 33 observations.

The authors report on 33 cases of which two were operated by 270 degrees fundoplication. Then they clinically study reflux gastroesophagitis and underline the great interest of Trendelenburg maneuver in X Ray case-finding of this syndrome. Finally, some modern methods of exploration are detailed, such as manometry, pH metry, scanning, their respective advantages and their usages in a tropical environment. They draw conclusion that symptomatology and X Ray ease a correct approach of reflux gastroesophagitis, in absence of any organic lesion. The only problem remaining, because of the lack of exploratory means, is how to evaluate, during the post-operative period, the surgical technics applied.

[The value of metronidazole in the indications for appendicectomy in a tropical environment. Apropos of 183 cases]. / Intérét du métronidazole dans l'indication d'une appendicectomie en milieu tropical. A propos de 183 cas.

This work was carried out consequently to three observations followed up by regrettable consequences: one right hemicolectomy about acute perforated typhlitis, two post-operative fistulae about clinical feature of pseudo-appendicitis. A study was undertaken on 183 patients; 160 patients complained of chronic in right iliac fossa, 23 of acute or subacute pain. Out of the 160 chronic patients, treated by metronidazole did not show symptoms anymore. Out of the 23 acute patients, 14 were cured thanks to the amebicide test-treatment and the 9 others showed during surgical intervention: 4 phlegmonous appendicitis, 3 appendicitis with inflammation of the mucous membrane, 2 appendicitis with abscess. In the acute cases, the duration of the therapeutic test was 10 ho. In the operated chronic cases (37 out of 160), histology substantiated surgery in revealing typical lesions of chronic appendicitis sometimes associated to anatomical deformity such as diverticulum. The authors strongly suggest such a test-treatment by metronidazole. It is well accepted and has enabled to get rid of post-operative morbidity of appendicectomy in tropical milieu.

[Biliary calculi in adults in Cameroon. Epidemio-clinical and morphological aspects (apropos of 52 cases seen in Yaounde)]. / La lithiase biliaire de l'adulte Camerounais. Aspects épidémio-cliniques et morphologiques (a propos de 52 cas observés à Yaoundé).

Fifty-two cases of cholelithiasis were retrospectively studied in the Central Hospital of Yaounde over a period of 30 months. Nineteen males and 33 females with an average age of 40 years (range from 15 to 70 years). Forty-six p.c. of these patients had asymptomatic cholelithiasis and most of it consisted in only one gallstone. Etiologic factors found were: sickle-cell anemia, obesity, pregnancy and cirrhosis.

Prostatic abscesses in sub-Saharan Africa: a hospital-based experience from Cameroon.

Abscesses of the prostate are encountered less frequently today and the bacteria responsible have changed over the years. Herein we report our experience with 6 patients with varying presentations. The role of imaging techniques in diagnosis and percutaneous needle aspiration of prostatic abscesses is highlighted.