[Whole-blood transfusion for hemorrhagic shock resuscitation: two cases in Djibouti]. / Transfusion de sang total pour la réanimation du choc hémorragique: à propos de deux cas à Djibouti.

Hemorrhagic shock requires early aggressive treatment, including transfusion of packed red blood cells and hemostatic resuscitation. In austere environments, when component therapy is not available, warm fresh whole-blood transfusion is a convenient treatment. It provides red blood cells, clotting factors, and functional platelets. Therefore it is commonly used in military practice to treat hemorrhagic shock in combat casualties. At Bouffard Hospital Center in Djibouti, the supply of packed red blood cells is limited, and apheresis platelets are unavailable. We used whole blood transfusion in two civilian patients with life-threatening non-traumatic hemorrhages. One had massive bleeding caused by disseminated intravascular coagulation due to septic shock; the second was a 39 year-old pregnant woman with uterine rupture. In both cases, whole blood transfusion (twelve and ten 500 mL bags respectively), combined with etiological treatment, enabled coagulopathy correction, hemorrhage control, and satisfactory recovery.

[Assessment of surgical teleconsultations in a developing country: two years of experience in Djibouti]. / Évaluation de la télé-expertise en chirurgie dans un pays en développement: une expérience de deux ans à Djibouti

OBJECTIVE: Our objective was to assess the influence of teleconsultations on patient management and clinical outcomes in a developing country. MATERIALS AND METHODS: All the surgical teleconsultations by a single surgeon (orthopedist) between November 2009 and November 2011 were recorded. RESULTS: Neurosurgery and pediatric orthopedics were the two most important specialities most often concerned, accounting for 67% of the 157 teleconsultations for 138 patients. The teleconsultations resolved the diagnostic uncertainties in 29 of 37 cases (78%). Advice from the expert modified management in 69% cases. Clinical outcomes were good or very good in 86% of the treated patients. CONCLUSIONS: This study establishes the feasibility and usefulness of surgical teleconsultations in Djibouti.

[Ulceration of the heel in a woman from Djibouti: squamous cell carcinoma with carcinomatous lymphangitis]. / Ulcération du talon chez une Djiboutienne: carcinome epidermoïde avec lymphangite carcinomateuse.

The purpose of this report is to describe a case in which a heel ulcer with atypical features, i.e., large size and rapid progression, led to diagnosis of squamous cell carcinoma. Patient management was based on specialist advice obtained by "tele-dermatology" based on pictures and comments transmitted over the Internet. However, due to the risk of spreading and impossibility of providing other medical treatment (radiotherapy-chemotherapy), the lower limb was amputated at the top of the thigh.