Our Experience of the De la Torre-Mondragon Technique in the Surgical Management of Hirschsprung's Disease: A Report on 52 Cases.

BACKGROUND: The authors report their experience of the transanal endorectal pull through technique as described by De la Torre Mondragon in the treatment of Hirschsprung's disease (HD). MATERIALS AND METHODS: It was a retro prospective, observational and descriptive hospital based study involving all proven cases of HD managed within a time frame of 8 years. RESULTS: Fifty two patients with a mean age of 18 months at the time of surgery. The male pre dominance was remarkable. The mean duration of the surgery was 2 h and a half hours. The surgical indication was based on the history, clinical findings and on the contrast enema (transition zone) with a 24 h film (prolonged contrast evacuation) and calculation of the rectosigmoid index (<1). With a mean follow up of 16 months, the morbidity was dominated by soiling, anastomotic strictures and enterocolitis. The mortality in one case was related to a post operative enterocolitis that was not amenable to resuscitation. CONCLUSION: Soiling, anastomotic strictures and enterocolitis are the main post operative complications of TEPT in the treatment of HD in our practice.

Bedside reduction of gastroschisis: A preliminary experience in yaounde-cameroon.

Background: Gastroschisis denotes a congenital or sporadic malformation of the anterior abdominal wall, which is rarely associated with other anomalies. The mortality in African countries is still high almost 100%. Objective: The aim was to determine the feasibility and safety of bedside reduction of gastroschisis and factors affecting the outcome in low-income setting. Methodology: This was a retrospective, descriptive and analytic study over a period of 6 years conducted in the Pediatric Surgery Service of the Yaoundé Gyneco-Obstetric and Pediatric Hospital. Only neonates with gastroschisis seen within 6 h of life without bowel necrosis and in whom bedside reduction was attempted in the neonatology unit under sedation (with 0.5 mg/kg of diazepam intra-rectally and 0.5-1 mg of atropine intravenously) were included in this study. Ethical clearance was obtained for the Ethical Committee of the Yaoundé Gyneco-Obstetric and Pediatric Hospital and a signed consent form was required from the parents of the children prior to the procedure. Results: Twelve neonates with a mean age of 16.8 h (0 and 24 h) and mean birth weight of 2245 g (1860-3600 g) were enrolled. The mean time to presentation at hospital was 3.5 h (2-9 h). Bedside closure was successful in 10 patients. Two patients underwent primary closure in the theatre after failure of bedside reduction due to the volume of contents of gastroschisis. Mortality rate in our study was 33.3% and the morbidity was dominated by compartment syndrome and malnutrition. Conclusion: Bedside reduction of gastroschisis under sedation in Yaoundé seems to be way to reduce the mortality.

Sleeve gastrectomy in the surgical management of obesity in Cameroon (a sub-Saharan country): A single-institute retrospective review of 30-day postoperative morbidity and mortality.

BACKGROUND: Obesity is a major public health concern even in sub-Saharan Africa. In this part of the world, characterized by limited technical platform and resuscitation facilities, sleeve gastrectomy in the surgical management of obesity is a quite new procedure. We aimed to assess intraoperative complications and 30-day postoperative morbidity and mortality of this procedure in our setting. METHODS: This study was conducted in the digestive and laparoscopic surgery unit of the National Insurance Fund Health Centre of Essos (Cameroon, Central Africa region). Retrospectively, we reviewed the medical reports of all patients who had undergone a bariatric surgery through a sleeve gastrectomy from January 2016 to December 2020. The 3 end points were intraoperative complications, postoperative 30-day morbidity, and postoperative 30-day mortality. RESULTS: We included 21 patients among whom 19 were female (90.5%). Their mean age and body mass index were 40.3 ± 10.8 years and 44.9 ± 7.4 kg/m2, respectively. All of them presented with at least 1 comorbidity. All procedures were totally completed laparoscopically with 3 cases of intraoperative complications (14.3%) consisting on bleeding in all of them. The mean operative time was 192.2 ± 52.8 minutes, and the mean hospital stay was 4.7 ± 1.1 days. Eight patients (38.1%) presented a total of twelve 30-day postoperative complications, all of them classified as minor according to the Clavien-Dindo method. The main postoperative morbidity was represented by nausea and vomiting (n = 3, 14.3%). No 30-day readmission was recorded, and the 30-day mortality was nil. CONCLUSION: Sleeve gastrectomy in the management of obesity is a safe procedure even in a limited setting like our own.

Anal/anogenital lesion revealing child sexual abuse: A case series of an unusual situation in a black African setting.

INTRODUCTION: Child sexual abuse (CSA) remains a big taboo in black Africa with an underestimated prevalence. In our context, the majority of cases are known by revelations of the child at least one year after the facts. PRESENTATION OF CASES: We report three cases of CSA revealed by an anal/anogenital lesion requiring surgery. All of these patients were female with ages ranging from 20 months to 8 years. The lesions encountered were: an anal abscess, a fissure-in-ano with permanent anal mucosal eversion and a complex perineal tear including partial anal sphincter rupture with partial section of the rectovaginal septum. The outcome was favorable in all cases after surgery. The abuser was subsequently able to be identified after the statements of two of these three children. DISCUSSION: Detection of anogenital lesions during a pediatric consultation should make practitioners aware of the possibility of sexual abuse. Surgical repair of these lesions can be simple or complex, requiring major reconstructions. In such cases, it's important to listening to the child's voice. CONCLUSION: Anogenital lesions discovered during pediatric consultation must evoke sexual abuse. The silence and the taboo surrounding these abuses in Africa must be break down.

Clinical epidemiology and mortality risk factors of gastric cancer in a sub-Saharan African setting: a retrospective analysis of 120 cases in Yaoundé (Cameroon).

INTRODUCTION: in sub-Saharan Africa, there is scare published data on cancer in general and gastric cancer in particular. METHODS: we conducted a multicenter retrospective analysis of the medical records of patients followed for gastric cancer in 5 hospital departments in the city of Yaoundé (Cameroon) over 6 years. RESULTS: we recorded a total of 120 patients with a mean age of 53.4 ± 13.7 years. There were 62 females (51.7%). The most common risk factors for gastric cancer in our patients was Helicobacter pylori infection (59 cases, 49.1%). Seventy-six patients (63.3%) consulted within 1 to 6 months of symptoms on set at the forefront of which chronic epigastralgia (74.1%). At endoscopy, the tumor was mostly located at the antrum and was locally advanced or metastatic in 25.8% and 58.4 of cases respectively. Adenocarcinoma was the main histologic type found in 105 (87.5%) cases. Curative treatment could only be implemented in 26.7% of patients. We noted a total of 85 deaths (70.8%) with a mean survival time of 5.91 ± 7.51 months. Survival rate at 3 and 5 years was 10.1% and 4.6%, respectively. On multivariable analysis, variables independently associated with overall survival included: WHO stage 3 performance status (p = 0.042), palpable epigastric mass on examination (p = 0.042), pyloric localization (p = 0.007), and liver metastasis (p = 0.012). CONCLUSION: clinical epidemiology of gastric cancer in our study is comparable to those of other African studies with a predominance of locally advanced/metastatic forms. Prognosis is grim with diagnostic delay behind all of the identified mortality risk factors.

Anterior approach in humeral plating osteosynthesis.

CONTEXT: Humeral plating osteosynthesis is controversial, particularly regarding the choice between anterior and lateral approach, data for which in the context of a low-income country are lacking. HYPOTHESIS: The anterior approach is an easy surgical technique, allowing good anatomic reconstruction. We hypothesize that the anterior approach is associated with fewer neurovascular lesions and functional sequelae than the lateral approach. MATERIALS AND METHODS: A retrospective study with assessment update was carried out over a period of 6years 4months from January 2010 to June 2016, with consecutive recruitment in the city of Yaoundé, Cameroon. It consisted in a review of medical records, with physical reassessment on pre-designed and tested data-sheet. Sixty-two osteosyntheses were documented in 60 subjects operated on for humeral fracture or non-union. The following variables were studied: sociodemographic data, fracture profile, clinical profile, and functional shoulder and elbow results. Data analysis used the Statistical Package for Social Sciences (SPSS), version 23.0. Associations between qualitative variables were assessed on Chi square test, or Fisher test when the expected sample size was less than 5, and between quantitative and qualitative variables on Student t-test for comparison of means; p values≤0.05 were considered statistically significant. RESULTS: The anterior approach showed better results. Operative time was shorter, at 102.5min on average, for 262cm3 blood loss, versus 141.6min and 330cm3 on the lateral approach, with a significant correlation between the two variables. The incidence of postoperative radial paralysis was significantly higher with the lateral approach (22.6% versus 3.2%; p=0.02), and there were likewise higher rates of postoperative infection (9.7% versus 6.5%), secondary displacement, implant damage, and malunion. Reduction was more often anatomical with the anterior approach (28.1% versus 11%) and cortical fixation was better (83.9% versus 61.3%). Functional shoulder and elbow recovery was nearly normal with both approaches, with superimposable values and no statistically significant difference in (p=0.4). CONCLUSION: Cameroon being a low-income country, the anterior approach is of therapeutic and prognostic interest, being easy to perform, with a low rate of postoperative complications and good functional outcome.

Infantile hypertrophic pyloric stenosis: a 4-year experience from two tertiary care centres in Cameroon.

OBJECTIVE: This study aimed to describe the clinical characteristics of patients with infantile hypertrophic stenosis, management and its outcome in two tertiary care centres in Cameroon. RESULTS: A total of 21 patients were included from the two centres. The mean age at presentation was 5.2 ± 1.2 weeks, predominantly male with a male-to-female ratio of 4.25:1. The triad of vomiting, visible peristalsis and palpable mass was present in only 7 (33.3%) of the participants. The diagnosis was confirmed with ultrasounds in all participants. Ramstedt pyloromyotomy was done in all participants and in 9.5% of the participants it was complicated by intra-operative duodenal perforation whereas in the postoperative period the most common complications were vomiting (6, 28.6%), sepsis (2, 9.5%), and paralytic ileus (2, 9.5%). The mortality rate from the series is 9.5%. According to univariate logistic regression: severe dehydration [OR = 5.41, 95% CI = (3.11-6.97), p = 0.002], hypokalaemia [OR = 2.63, 95% CI = (1.02-5.91), p = 0.042] and surgical site infection [OR = 3.12, 95% CI (1.22-5.64), p = 0.023] were the main predictors of mortality whereas postoperative hospital length of stay > 5 days was significantly associated with surgical site infection [OR = 2.44, 95% CI = (1.12-6.44), p = 0.002] and postoperative nausea and vomiting [OR = 3.64, 95% CI = (1.18-6.64), p = 0.022].

Mise au point sur la rédaction des certificats médicaux et médico-légaux

Le certificat médical est l'attestation écrite des constatations cliniques et paracliniques d'un patient. Sa rédaction doit suivre des règles de prudence et d'objectivité permettant la réponse à l'objet qui a motivé sa demande. Tandis que le certificat médical ordinaire est établi à la demande du patient pour l'obtention d'avantages sociaux ou administratifs, le certificat médico-légal est quant à lui établi à la demande du patient, de l'officier de police judiciaire ou du juge, dans un objectif judiciaire. C'est un document essentiel dans les procédures consécutives à des coups ; blessures. Il doit être écrit avec précision et détails, et indiquer en conclusion la durée de l'incapacité totale de travail (ITT), laquelle, exprimée en nombre de jours permettra au juge de qualifier les dommages corporels. Cette mise au point a donc pour objectifs de rappeler les principales règles de rédaction des certificats médicaux et médico-légaux, et de proposer à titre indicatif des ITT pouvant orienter l'évaluation du médecin

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.

Hypertrophic pyloric stenosis in infants: is it a congenital or acquired disorder? Reflections on 2 cases.

Based on evidence from two collected and treated clinical observations of hypertrophic pyloric stenosis in children of 5 and 12 months of age, the authors give their point of view on the unresolved issue of the etiology of hypertrophic pyloric stenosis. They emphasize that there are more and more factors to prove this is an acquired condition.

À partir de 2 observations cliniques colligées et traitées de sténose hypertrophique du pylore chez les nourrissons de 5 mois et 12 mois, les auteurs font part de leurs réflexions sur la question non encore résolue de l'étiologie de la sténose hypertrophique du pylore. Ils soulignent l'existence de plus en plus de facteurs en faveur d'une affection acquise.

Association of inconclusive sera for human immunodeficiency virus infection with malaria and Epstein-Barr virus infection in Central Africa.

Among 464 sera from adults in Cameroon, 56 (12.1%) gave inconclusive HIV serology. All were negative for HIV-1 DNA; 44.6% (n = 25) were significantly associated with Plasmodium (42.8%) or Epstein-Barr virus (EBV) (17.8%) infections. In Central Africa, sera giving inconclusive results for HIV are frequently associated with malaria, EBV infection, or both.

[Aspects of the epidemiology, diagnosis and management of sickle cell osteomyelitis in children in Africa]. / Particularités épidémiologiques, diagnostiques et thérapeutiques de l'ostéomyélite drépanocytaire de l'enfant en milieu africain.

IntroductionSickle cell osteomyelitis in children is one of the complications of osteoarthritis in sickle cell disease.ObjectiveTo describe the epidemiology, diagnosis and treatment of sickle cell osteomyelitis in children in Africa to improve management.Tools and methodA review of records showed that from April 2004 through September 2009, eleven cases of osteomyelitis in children aged 0 to 15 years who carried the sickle cell trait were treated in the surgical and pediatric unit of the Women's and Children's Hospital of Yaounde.ResultThe children's mean age was 7 years, but frequency was highest for those aged 1 to 5 years. The sex ratio was 2:1 male. The portal of entry was found for only 30% of cases. The predilection of the disease for long bones, the non-fistulated forms, the homozygous type, and the frequency of Salmonella were all remarkable. Medical and preventive treatment, always applied, were followed by orthopedic treatment. The usefulness of surgery, on the other hand, is subject to debate. Healing was obtained in 80% of cases.ConclusionThe authors describe the profile of osteomyelitis in children with sickle cell disease in Africa.

Neurinomes et neurofibromes spinaux diagnostic et resultats du traitement chirurgical a Yaounde

Description les neurinomes et neurofibromes spinaux restent très peu étudiés en Afrique sub-saharienne. Objectif rapporter les résultats du traitement chirurgical des neurinomes et neurofibromes spinaux à Yaoundé. Méthodes étude rétrospective menée à l'Hôpital Général et à l'Hôpital Central de Yaoundé, du 1er Janvier 1995 au 1er Janvier 2005. Critères d'inclusion: dossier médical comprenant les résultats de l'examen clinique pré et post opératoire, ceux des examens neuroradiologiques et histopathologiques, le compte rendu opératoire. Un suivi post-opératoire minimal de six mois. Le résultat fonctionnel été évaluée par l'échelle de Karnofsky. Résultats sur 62 patients opérés d'une tumeur intrarachidiennes, 12 (19,35 %) ont été sélectionnés (neuf neurinomes, deux neurofibromes, un neurofibrosarcome). L'age moyen était de 40,66 ans ±13,20, le sex ratio 0,71. La durée moyenne de symptômes avant le diagnostic était de 17,83 mois ± 5,81, extrêmes 6 et 28 mois ; le signe d'appel le plus fréquent était la radiculalgie (six cas). Cinq patients étaient paraplégiques. Le score de Karnofsky moyen préopératoire était de 50,00 ±12,79 et de 70,83±23,53 en postopératoire. Le siège tumoral était cervical (quatre cas), dorsal (six cas), lombaire (deux cas). La tumeur était extradurale dans six cas, intra durale quatre, intra et extradurale deux cas. L'exérèse était macroscopiquement complète dans neuf cas, partielle dans trois. Cinq patients ont connu une amélioration permettant une réinsertion professionnelle. Conclusion le diagnostic des neurinomes et neurofibromes reste tardif dans notre environnement, ce qui limite le résultat chirurgical