Mortality of head injuries in Sub-Saharan African countries: The case of the university teaching hospitals of Cameroon.

BACKGROUND: Reliable data on severe head injury mortality is rarely reported in Sub-Saharan African countries and in Cameroon in particular. It was for this reason that for the first time ever a prospective study was carried out during a one year period in the university hospitals and some selected regional and district hospitals in Cameroon. MATERIALS AND METHODS: All the patients admitted for head injury in the emergency units of the selected hospitals were enrolled and followed up over a period of one month. RESULTS: A total of 2835 consecutive patients were included with a sex ratio M/F=3.7/1. One hundred and seventy nine (179) patients lost to follow up were not included. The mortality rate was 77% in the severe head injury group, 16% in the moderate head injury group and 1% in the mild head injury group. In the group of severely injured patients, the mortality rates were very high in the academic hospitals (Laquintinie Hospital of Douala, General Hospital of Douala, Yaounde Central Hospital, and Yaounde University Hospital; 83%, 83%, 81%, and 73% respectively) and in the Regional Hospital of Garoua (84%). CONCLUSION: Mortality rates associated with head injury remain very high in Cameroon, and this is likely true in many countries across Sub-Saharan Africa. The figures approach the mortality expected in the natural history of the disease. Strategic plans should be taken at the local and national levels as in the case of maternal mortality and HIV infections.

[Preliminary study of laparoscopic cholecystectomy in Cameroon]. / Expérience préliminaire de la cholécystectomie par voie laparoscopique au Cameroun.

AIM: The purpose of this study was to evaluate the feasibility of laparoscopic cholecystectomy in Cameroon. MATERIALS AND METHOD: This retrospective study includes all patients who underwent laparoscopic cholecystectomy in three major hospitals in Cameroon from 2001 to 2009. Charts were reviewed for epidemiological data, complications, and outcome. RESULTS: This study included 52 patients. Their mean age was 45 years (range: 17-71). All had symptomatic gallstones, and 15 presented acute cholecystitis. The rate of conversion to open surgery was 7.7%. No deaths occurred. One patient required reoperation due to cystic duct stump leakage complicated by biliary peritonitis. The average duration of hospitalization was 3 days. CONCLUSION: Based on these results, we recommend laparoscopic cholecystectomy for symptomatic gallstones in Cameroon.

[Cardiac surgery in Cameroon. Results at one year of the pilot phase]. / Chirurgie cardiaque au Cameroun. Résultats à un an de la phase pilote.

In the framework of implementation of his national program for control and prevention of cardiovascular diseases, Cameroonian government has set up a cardiac surgery project. We report in this manuscript results of one year follow up of the patients operated during the pilot phase. From September 22 till 26, 2008, 11 patients have been operated in Cameroun. Surgical procedures were 5 mitral mechanic valve replacement, 2 aortic mechanic valve replacement, 1 atrial septal defect closure, 2 pace maker implantation. No intrahospital death was observed. One patient died at 11th month after the operation due to mitral valve thrombosis and attributed to lack of compliance. One patient presented low cardiac output, pneumonia and a pleural effusion. 2 patients presented 2 minor complications consisting of pericarditis and superficial wound infection. The results of the pilot phase of cardiac surgery in Cameroon are effective. However, the sustainability of the program require human, material capacity building, and funding mechanism as well.

[Difficulties in the management of esophageal atresia in developing countries]. / Problematique de la prise en charge de l'atresie de l'œsophageen pays sous medicalises.

Oesophageal atresia is an extreme surgical emergency of the first week of birth. Authors report 10 cases treated in 5 years in two hospitals of Yaounde in Cameroon. This study high line: Difficulties of oesophageal atresia management in less medicalised countries. Possible solutions in this context.

Problematique de la prise en charge de l'atresie de l'oesophage en pays sous medicalises

L'atresie de l'oesophage est une extreme urgence chirurgicale de la 1ere semaine de vie. Les auteurs en rapportent 10 cas colliges et traites en 5 ans dans deux hopitaux de la ville de Yaounde au Cameroun. Cette etude met en relief : - les difficultes de la prise en charge de l'Atresie de l'oesophage en pays sous medicalises - les solutions possibles dans ce contexte

Implant orthopaedic surgery in HIV asymptomatic carriers: management and early outcome.

BACKGROUND: To the best of our knowledge, no reports currently exist on how to manage HIV infected patients in cases where they present with an absolute indication for implant surgery. The aim of this study was to compare the immediate and early outcome of implant orthopaedic surgery in HIV carriers with less than 500CD4/ml (group A) treated with a protective antiretroviral therapy and prolonged prophylactic antibiotic therapy in one group, and in the other group, HIV carriers with more than 500CD4/ml (group B) and non-HIV carriers (group C) treated conventionally. METHODS: During a 36-month-period, a protocol of screening and subsequent management of HIV carriage was proposed to patients admitted for internal clean trauma or orthopaedic implant surgery in our department. The HIV screening, its confirmation and the CD4 count were carried out by conventional methods. All group A patients were treated with cefuroxime for 10 days and a fixed combination of antiretroviral tritherapy before or just after surgery. Group B and C patients solely underwent surgery with a conventional 1.5g of cefuroxime. The wounds in the three groups were later examined at days 2, 7, 14, 45 and at 3 months. The rates of clinical wound infection were compared using the Fisher exact test; the difference was considered significant if p

[Abdominal gunshot wound: description of 86 cases in Cameroon]. / La plaie abdominale par balle: à propos de 86 observations au Cameroun.

Abdominal gunshot wound (AGSW) is a trauma emergency. The purpose of this report is to describe our experience with managing AGSW largely without modem investigational modalities. Data was collected retrospectively by reviewing the surgical reports and clinical charts of patients admitted to live hospitals dealing with AGSW over a 5-year period. Incomplete files and wounds not involving the abdomen were not included. A total of 86 files were analyzed. Patients ranged in age from 10 to 63 years ivith mean age of 32 years and a sex ratio of 5.5. Most patients (87%) underwent surgical exploration. Laboratory revealed no lesions in 22.5% of cases, minor lesions in 9.5% and major lesions justifying surgical repair in 68%. A total of 86 visceral lesions were found in the patients who underwent surgical exploration. The lesion involved the small intestine in 31.5% of case, colon in 24.5%, liver in 23.5%, spleen in 7%, stomach in 6%, and uterus in 2%. The kidney, pancreas, mesenteries, large momentum, and transverse mescaline each accounted for 1% of lesions. Conventional operative techniques were used with a mortality of 5.5% and morbidity of 4%. Based on our findings we conclude that when investigational tools (CT-scan, peritoneal lavage and laparoscopy) are unavailable prolonged watchful waiting increases the risk of mortality and morbidity in patients presenting AGSW associated with suspicious clinical signs. Prompt surgical treatment improves prognosis but is associated with a high rate of cases showing no lesions.

Traumatic pseudoaneurysm of the pulmonary artery: case report and review of the literature.

Pulmonary artery pseudoaneurysm is a very rare but potential complication of chest trauma. These aneurysms are usually produced by penetrating trauma although a few cases have been reported after blunt injury. They should be suspected if there is a persistence of opacity on chest radiograph that when evaluated by contrast-enhanced CT shows an increased opacification of the mass. Diagnosis is confirmed with a pulmonary arteriogram.

[Antitumor activity of several new pentopyranosyl-chloroethylnitrosoureas]. / Activité antitumorale de quelques nouvelles chloroéthyl-nitrosourées pentopyranosiques.

Six N-(2-chloroethyl)-N-nitrosoureido derivatives of 4-deoxy-DL-pentopyranose have been synthesized and their antitumor activities were evaluated against melanoma MB16 in mice. The nitrosourea 38 was highly active in comparison with the clinically useful CCNU.