Teaching humanitarian surgery: Filling the gap between NGO needs and subspecialized surgery through a novel inter-university certificate.

Background: Access to surgical care is a global health burden. A broad spectrum of surgical competences is required in the humanitarian context whereas current occidental surgical training is oriented towards subspecialties. We proposed to design a course addressing the specificities of surgery in the humanitarian setting and austere environment.Method: The novelty of the course lies in the implication of academic medical doctors alongside with surgeons working for humanitarian non-governmental organizations (NGO). The medical component of the National Defense participated regarding particular topics of war surgery. The course is aimed at trained surgeons and senior residents interested in participating to humanitarian missions.Results: The program includes theoretical teaching on surgical knowledge and skills applied to the austere context. The course also covers non-medical aspects of humanitarian action such as international humanitarian law, logistics, disaster management and psychological support. It comprises a large-scale mass casualty exercise and a practical skills lab on surgical techniques, ultrasonography and resuscitation. Attendance to the four teaching modules, ATLS certification and succeeding final examinations provide an interuniversity certificate.30 participants originating from 11 different countries joined the course. Various surgical backgrounds, training levels as well as humanitarian experience were represented.Feedback from the participants was solicited after each teaching module and remarks were applied to the following session. Overall participant evaluations of the first course session are presented.Conclusion: Teaching humanitarian surgery joining academic and field actors seems to allow filling the gap between high-income country surgical practice and the needs of the humanitarian context.

Primary mediastinal tumors.

Primary mediastinal tumours (PMT) are rare, they include many different histological types, but lymphomas, thymomas and neurological tumours make up most of these tumours. Their symptomatology is often poor and they are in many cases discovered by routine thoracic radiography. Diagnosis mainly relies on medical imagery and on biopsy by mediastinoscopy or by CT-Scan controlled needle puncture. The treatment depends on the histological type (radiotherapy, chemotherapy, surgery). Median sternotomy is preferred to tackle anterior and middle mediastinum PMT, since it offers a large operative field and is more comfortable for the patient than classic thoracotomy, which will be reserved to tackle posterior mediastinum PMT.

[Histopathological findings: (apropos of 395 thyroidectomies in Burundi)]. / Données histopathologiques: (à propos de 395 thyroïdectomies au Burundi).

Analysis of 395 thyroidectomies, in a tropical region of endemic goiter and in a Hospital Department without any mean of investigation of thyroid gland, led to the establishment of the following facts: Prevalence of female sex is clear (72.1 p.c.). Thyrotoxicosis appears to be infrequent (1.5 p.c.). Cancer of thyroid strikes 7.8 p.c. of the operated patients. Operative morbidity is 3 p.c. Lesions of the recurrent laryngeal nerve have been observed in 3.8 p.c. of the patients. Then these results are examined in light of the date of known publications.