Brachiocephalic A-V fistula through the median cubital vein; A reliable option to failure of forearm fistulas. A case report from CHU Yaoundé.

INTRODUCTION: Renal replacement therapy in end-stage kidney disease relies on dialysis in low-income countries. This maintenance treatment needs a reliable vascular access and is done through central venous catheter or creation of A-V fistulas. Several types of A-V fistulas can be done but due to some individual conditions, those possibilities may be exhausted rapidly. CASE PRESENTATION: A 31 year old female was diagnosed with an end stage renal disease for which she was prescribed maintenance dialysis. She first denied her condition and went to traditional healer. After some months her clinical state worsened and she was dialyse with catheter and refer to us for A-V fistula construction. The first two attempts on the forearm failed and we found small radial artery both proximally and distally on the left forearm. We finally did a left brachiocephalic fistula with initial retrograde flow on the median cubital vein. DISCUSSION: Despite arm base fistula may be theoretically easy to build because of bigger size vessels, brachiobasilic fistula may be less effective due to difficult venipuncture. Brachiocephalic fistula through median cubital vein may be more effective option with no further procedure needed. CONCLUSION: Brachiocephalic fistula should be considered as option in vascular access especially when a reliable option is needed after previous attempt failure.

Paediatric fractures in a sub-saharan tertiary care center: a cohort analysis of demographic characteristics, clinical presentation, therapeutic patterns and outcomes.

INTRODUCTION: Paediatric fractures are often of good prognosis due to auto-correction of insufficient fracture reduction by bone remodeling. In sub-Saharan Africa, traditional healers are renowned for managing fractures and there is a neglect for specialized pediatric fracture care. We aimed to determine the demographic characteristics, clinical presentation, treatment patterns and outcomes of paediatric fractures in a tertiary health care centre in Yaoundé. METHODS: We conducted a prospective cohort study of all consenting consecutive cases of fractures in patients younger than 16 years managed between January 2011 and June 2015 at the University Teaching Hospital, Cameroon. We analysed demographic data, injury characteristics, fracture patterns, treatment details, therapeutic challenges and outcome of treatment at 12 months of follow-up. RESULTS: We enrolled 147 fractures from 145 children with a mean age of 7 years and male-to-female sex ratio of 2.5:1. The main mechanisms of injury were games (53%) and accidental falls (20.7%). Forearm fractures were the most common fractures (38%). The mainstay of management was non-operative in 130 (88.5%) fractures, with 29.3% manipulations under anesthesia and 17 (11.5%) open reductions with internal fixation. The most surgically reduced fractures were supracondylar humeral fractures. Major difficulties were long therapeutic delay, lack of diligent anaesthesia and the lack of fluoroscopy. The outcome of treatment was favorable in 146 (99.3%) paediatric fractures. CONCLUSION: With the growing population of sub-Saharan Africa and the objective of becoming an emergent region, public policies should match the technical realities.

Management of tethered cord syndrome in adults: a case report in Cameroon.

Tethered cord syndrome (TCS) is spinal cord fixation from multiple pathological entities. No case of TCShas been reported in our region. The goal of this case report was to describe a TCS managed at the Douala General hospital. Mrs. EEL, 23 year old consulted in 2012 for urinary and fecal incontinence. She had a past history of a spina bifida at birth operated on day two of life. On admission, lumbar MRI showed an abnormally low lying conus medullaris ending at S. Microsurgery permitted to gradually detach the spinal cord from subcutaneous tissue and carefully free the spinal nerves. A 12 months post-surgery, the patient could control defecation, and achieve proper micturition. TCS should also be ruled out in patients who present with urinary and ano-rectal symptoms especially of childhood onset; more so with present day availability of modern radiological tools like MRI.

Meckel's diverticulum: a case report from the University Hospital Center Yaoundé, Cameroon.

To the best of our knowledge there is no reported case of Meckel's diverticulum (MD) in Cameroon. The prevalence of MD in the general population is 2-3 %. The aim of this paper is to recapitulate the role of this pathology in acute abdomens and abdominal pain of uncertain aetiology in young patients and to review the medical literature.