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Kamla JI, Bang GA, Tochie JN, Bwelle GM, Oumarou BN, Nonga BN. Perioperative outcomes of the surgical management of achalasia in two tertiary Cameroonian hospitals: a cohort study. BMC Gastroenterol 2024; 24:118. [PMID: 38519934 PMCID: PMC10958949 DOI: 10.1186/s12876-024-03191-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 02/29/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION Achalasia is a rare esophageal disease with potentially lethal complications. Knowledge of the outcomes of the different surgical treatment modalities for achalasia by Heller's cardiomyotomy (HCM) helps to choose the safest and most effective option. However, data on the management of achalsia using a Heller myotomy is limited in Africa. Thus, our aim was to determine the perioperative morbidity, mortality and short-term functional outcomes of HCM in Cameroon. METHODOLOGY We conducted a cohort study throughout a 10-year chart review of patients who underwent HCM for achalasia and were followed up postoperatively for at least three months at two tertiary health centers in Cameroon. We analyzed demographic data, preoperative clinical and imaging data, treatment details, and outcomes at three to twelve months after HCM using the Eckardt score. RESULTS We enrolled 29 patients with achalasia having a mean age of 24 ± 16 years and predominantly females (M/F of 1/3.8). The mean symptom duration was 51 ± 20 months. In 80% of cases, the diagnosis was made through a conventional x-ray contrast imaging or "barium swallow test" (93%) and/or an upper gastrointestinal endoscopy (86%). The gold standard diagnostic method via esophageal manometry was unavailable. Preoperatievly, all patients had symptoms suggestive of an active achalasia. HCM was performed via laparotomy in 75% as opposed to 25% laparoscopic HCM procedures. Dor's anterior partial fundoplication was the main anti-reflux procedure performed (59%). Mucosal perforations were the only intraoperative complications in eight patients (2 during laparoscopy vs. 6 during laparotomy; p > 0.5) and were managed successfully by simple sutures. Postoperative complications were non-severe and occurred in 10% of patients all operated via laparotomy. The mean postoperative length of hospital stay was 7 ± 3 days for laparotomy vs. 5 ± 2 days for laparoscopy; p > 0.5. The perioperative mortality rate was nil. Overall, the short-term postoperative functional outcome was rated excellent; average Eckardt score of 1.5 ± 0.5 (vs. preoperative Eckardt Score of 9 ± 1; p < 0.0001). CONCLUSION Achalasia is diagnosed late in this resource-limited setting. HCM yields satisfactory outcomes, especially via laparoscopic management. An improvement in diagnostic esophageal manometry and mini-invasive surgical infrastructure and the required surgical training/skills are needed for optimal achalasia care.
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Affiliation(s)
- Joël Igor Kamla
- Department of Surgery, University Hospital Center, Yaoundé, Cameroon.
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
| | - Guy Aristide Bang
- Department of Surgery, University Hospital Center, Yaoundé, Cameroon
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - George Motto Bwelle
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Visceral-Gastrointestinal Surgical unit, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Blondel Nana Oumarou
- Department of Visceral-Gastrointestinal and Laparoscopy surgery, National Insurance Fond Hospital, Yaoundé, Cameroon
| | - Bernadette Ngo Nonga
- Department of Surgery, University Hospital Center, Yaoundé, Cameroon
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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Fola OK, Jemea B, Bayiha JEE, Nonga BN. Successful management of oesophageal atresia in Cameroon, Sub-Saharan Africa. Afr J Paediatr Surg 2023; 20:138-143. [PMID: 36960510 DOI: 10.4103/ajps.ajps_47_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Oesophageal atresia (EA) is the most common congenital anomaly of the oesophagus. Despite improvement of survival observed over the previous two decades in developed countries, the mortality remains very high and the management greatly challenging in resource-poor settings such as Cameroon. We report our experience of management of EA in this environment, with a successful outcome. Materials and Methods We prospectively assessed patients diagnosed with EA and operated in January 2019, at the University Hospital Centre of Yaounde. Records were reviewed for demographics, history and physical examinations, radiological findings, surgical procedures and outcomes. The study has received approval from the Institutional Ethics Committees. Results In total, six patients (three males and three females, sex ratio, 0.5; mean age at diagnosis, 3.6 days; range, 1-7 days) were assessed. A past history of polyhydramnios was found in one patient (16.7%). All patients were classified Waterston Group A at diagnosis, with Ladd-Swenson type III atresia. Early primary repair was performed in four patients (66.7%) and delayed primary repair in two patients (33.3%). Operative repair mainly involved resection of the fistula, suture of trachea and oesophagus end-to-end anastomosis, followed by interposition of vascularised pleural flap. Patients were followed up 24 months. With one late death, the survival rate was 83.3%. Conclusion Improvement has been achieved in the outcomes of neonatal surgery in Africa in the past two decades, but EA-related mortality remains relatively too high. Using simple techniques and available, reproducible equipment can improve survival in resource-poor settings.
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Affiliation(s)
- Olivier Kopong Fola
- Department of Surgery, University Hospital Centre of Yaounde, University of Yaounde I, Yaounde, Cameroon
| | - Bonaventure Jemea
- Department of Anesthesia and Intensive Care Unit, University Hospital Centre of Yaounde, University of Yaounde I; Department of Surgery and Subspecialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | | | - Bernadette Ngo Nonga
- Department of Surgery, University Hospital Centre of Yaounde, University of Yaounde I; Department of Surgery and Subspecialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
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Nonga BN, Jemea B, Pondy AO, Handy Eone D, Bitchong MC, Fola O, Nkolaka A, Londji GM. Unusual Life-Threatening Pneumothorax Complicating a Ruptured Complex Aspergilloma in an Immunocompetent Patient in Cameroon. Case Rep Surg 2018; 2018:8648732. [PMID: 29666746 PMCID: PMC5832132 DOI: 10.1155/2018/8648732] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 10/12/2017] [Accepted: 01/30/2018] [Indexed: 11/30/2022] Open
Abstract
An aspergilloma is a well-recognized lesion of the lung caused most of the time by the fungus Aspergillus fumigatus. Its main complication is hemoptysis and has been very rarely associated with tension pneumothorax. We present the case of a 47-year-old man with a history of treated and healed tuberculosis, which was successfully managed in our service for a ruptured right upper lobe complexed aspergilloma, complicated by a massive and tension pneumothorax. The patient underwent thoracotomy and lung resection with quick recovery. Conclusively, although rare, an aspergilloma may rupture and cause a life-threatening air leakage.
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Affiliation(s)
- Bernadette Ngo Nonga
- Department of Surgery, University Hospital Centre of Yaoundé, University of Yaoundé I, Yaounde, Cameroon
| | - Bonaventure Jemea
- Department of Anesthesia and Intensive Care Unit, University Hospital Centre of Yaoundé, University of Yaoundé I, Yaounde, Cameroon
| | - Angele O. Pondy
- Department of Pediatrics, University of Yaoundé I, Yaounde, Cameroon
| | - Daniel Handy Eone
- Department of Surgery, University Hospital Centre of Yaoundé, University of Yaoundé I, Yaounde, Cameroon
| | - Marie Claire Bitchong
- Department of Medicine, Faculty of Medicine and Pharmaceuticals Sciences, University of Douala, Douala, Cameroon
| | - Olivier Fola
- Department of Surgery, University Hospital Centre of Yaoundé, University of Yaoundé I, Yaounde, Cameroon
| | - Atems Nkolaka
- Department of Surgery, University Hospital Centre of Yaoundé, University of Yaoundé I, Yaounde, Cameroon
| | - Gilles Martin Londji
- Department of Surgery, University Hospital Centre of Yaoundé, University of Yaoundé I, Yaounde, Cameroon
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Ngo Nonga B, Bang GA, Jemea B, Savom E, Yone P, Mbatchou N, Ze JJ. Complex Pulmonary Aspergilloma: Surgical Challenges in a Third World Setting. Surg Res Pract 2018; 2018:6570741. [PMID: 29594190 PMCID: PMC5821956 DOI: 10.1155/2018/6570741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/14/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Surgery for pulmonary aspergilloma (PA), especially complex forms, is greatly challenging in a resource-poor setting such as Cameroon. We report our experience of surgical management of PA in this environment. METHOD We prospectively assessed patients who underwent surgery for PA from January 2012 to May 2015, at the University Hospital Center of Yaoundé. Records were reviewed for demographics, history and physical examinations, radiological findings, surgical procedures, and outcomes. The study has received approval from the institutional ethics committees. RESULTS In total, 20 patients (17 males and 3 females (sex ratio, 5.66); mean age, 30 years; range, 23-65 years) with a past history of tuberculosis were assessed. The median follow-up was 21.5 months. The primary symptom was hemoptysis, followed by cough and chest pain. All patients underwent surgical treatment and lung resection. Postoperative complications (bleeding, air leak, empyema, and severe anemia) occurred in 4 patients and 1 patient died. Although 3 patients were lost to follow-up, the survival rate was 80% with improvement of the preoperative symptoms. CONCLUSION Although surgery for complex aspergilloma is very challenging in environments such as ours, we believe that it is the best treatment modality for symptomatic diseases in our setting.
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Affiliation(s)
- Bernadette Ngo Nonga
- Department of Surgery, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Guy Aristide Bang
- Department of Surgery, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Bonaventure Jemea
- Department of Surgery and Specialties, Service of Anesthesia, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Eric Savom
- Department of Surgery, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Perfura Yone
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Ngahane Mbatchou
- Department of Internal Medicine, Faculty of Medicine and Pharmacy, University of Douala, Douala, Cameroon
| | - Jean Jacques Ze
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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Eone DH, Lamah L, Bayiha JE, Ondoa DLE, Nonga BN, Ibrahima F, Bahebeck J. [Assessment of concomitant floating knees injuries severity]. Pan Afr Med J 2016; 25:83. [PMID: 28292046 PMCID: PMC5324143 DOI: 10.11604/pamj.2016.25.83.7920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 03/20/2016] [Indexed: 11/30/2022] Open
Abstract
Le genou flottant est issu d’un traumatisme de haute énergie, dont la genèse suggère de vaste dégâts aussi bien sur le plan locorégional que général. Faisant référence au polytaumatisme. Le but de notre étude était de recenser toutes les lésions concomitantes au genou flottant dans notre milieu de pratique et d’évaluer la sévérité. Nous avons mené une étude descriptive et rétrospective couvrant une période de 14 ans et 9 mois. Sur un échantillon de 75 genoux flottants, avec une moyenne d’âge de 35 ans. Soixante six patients avaient obtenu un score d’ISS supérieur ou égal à 16 donc qualifié de polytraumatisé. Les traumatismes crâniens, les lésions thoraciques et abdominales retrouvés en même temps que le genou flottant exigent une réanimation adéquate.
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Affiliation(s)
- Daniel Handy Eone
- Service de Chirurgie Orthopédique et de Traumatologie de l'Appareil Moteur (S.C.O.T.A.M) Hôpital Central de Yaoundé, Cameroun
| | - Léopold Lamah
- Service d'Orthopédie - Traumatologie CHU, Yaoundé, Cameroun
| | - Jean Emile Bayiha
- Service de Chirurgie Orthopédique et de Traumatologie de l'Appareil Moteur (S.C.O.T.A.M) Hôpital Central de Yaoundé, Cameroun
| | - Danielle Larissa Essomba Ondoa
- Service de Chirurgie Orthopédique et de Traumatologie de l'Appareil Moteur (S.C.O.T.A.M) Hôpital Central de Yaoundé, Cameroun
| | | | | | - Jean Bahebeck
- Service de Chirurgie Orthopédique et de Traumatologie de l'Appareil Moteur (S.C.O.T.A.M) Hôpital Central de Yaoundé, Cameroun
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Ankouane F, Noah DN, Enyime FN, Ndjollé CM, Djapa RN, Nonga BN, Njoya O, Ndam ECN. Helicobacter pylori and precancerous conditions of the stomach: the frequency of infection in a cross-sectional study of 79 consecutive patients with chronic antral gastritis in Yaoundé, Cameroon. Pan Afr Med J 2015; 20:52. [PMID: 26090010 PMCID: PMC4449994 DOI: 10.11604/pamj.2015.20.52.5887] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/15/2015] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The study aimed at determining the different types of precancerous conditions of the stomach and searches the frequency of Helicobacter pylori in these lesions in patients with chronic antral gastritis in Yaounde, Cameroon. METHODS Five gastric biopsies were performed during upper gastrointestinal endoscopy for pathology and fixed in formol 10% before being coated in paraffin. Both the modified Giemsa and Periodic acid of Shift - Alkaline blue stains were used for the histological diagnosis of Helicobacter pylori infection. Hematoxylyn and eosin stain was used to determine the activity of gastritis, atrophic gastritis and intestinal metaplasia in accordance to the Sydney's classification of gastritis. Data were analysed using both the Epi info 6.04 and Excel 2007 softwares. Means and their standard deviations, medians and their interquartiles (IQR) were calculated. Proportions were established for qualitative variables and chi square analysis done in this study with a p value set at 0.05. RESULTS Seventy-nine patients with chronic antral gastritis were enrolled, of which 43 (54.4%) were male, median age: 43 years (range from 21 to 70 years). The rate of atrophic gastritis was 74.7% (59/79). The activity of atrophic gastritis was mild in 47.5% (28/59) of cases, moderate in 47.5% (28/59) and severe in 5% (5/59). Intestinal metaplasia and follicular gastritis were present in 6.3% (5/79), and 10.1% (8/79), respectively. Concerning Helicobacter pylori infection, 71.2% (42/59) of patients with atrophic gastritis tested positive against 28.8% (17/59) who tested negative (p=0.00003). Helicobacter pylori infection was related to the severity of gastric atrophy (p=0.0001). Among patients with intestinal metaplasia and follicular gastritis, the proportion of those who tested positive for Helicobacter pylori infection was 80% (4/5), and 75% (6/8), respectively. There were no significant differences in the occurrence of atrophic gastritis according to age groups (p=0.908). CONCLUSION This study concludes that atrophic gastritis, which is most often caused by Helicobacter pylori, is the most frequent precancerous condition of stomach in Cameroon. Routine gastric sampling for pathologic analysis is mandatory for effective diagnosis and surveillance of Helicobacter pylori infection and precancerous conditions of the stomach.
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Affiliation(s)
- Firmin Ankouane
- Department of internal medicine and specialties, Faculty of medicine and biomedical sciences, University of Yaounde 1, Cameroon
| | - Dominique Noah Noah
- Department of clinical sciences, Faculty of medicine and pharmaceutical sciences, University of Douala, Cameroon
| | - Félicien Ntoné Enyime
- Department of internal medicine and specialties, Faculty of medicine and biomedical sciences, University of Yaounde 1, Cameroon
| | - Carole Menzy Ndjollé
- Department of morphological sciences, anatomy and pathology, Faculty of medicine and biomedical sciences, University of Yaounde 1, Cameroon
| | - Roger Nsenga Djapa
- Department of internal medicine and specialties, Faculty of medicine and biomedical sciences, University of Yaounde 1, Cameroon
| | - Bernadette Ngo Nonga
- Department of surgery and specialties, Faculty of medicine and biomedical sciences, University of Yaounde 1, Cameroon
| | - Oudou Njoya
- Department of internal medicine and specialties, Faculty of medicine and biomedical sciences, University of Yaounde 1, Cameroon
| | - Elie Claude Ndjitoyap Ndam
- Department of internal medicine and specialties, Faculty of medicine and biomedical sciences, University of Yaounde 1, Cameroon
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Andoulo FA, Noah DN, Djapa R, Kowo M, Talla P, Medjo EH, Djomkam IK, Nonga BN, Njoya O, Ndam ECN. Epidemiology of hepatitis C: related hepatocellular carcinoma in Cameroon. Pan Afr Med J 2014; 19:379. [PMID: 25977742 PMCID: PMC4427468 DOI: 10.11604/pamj.2014.19.379.4143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 09/03/2014] [Indexed: 11/11/2022] Open
Abstract
Introduction Hepatocellular carcinoma (HCC) is a global public health problem. Hepatitis C virus (HCV) infection accounts for close to 24% of HCC in developing countries especially when associated with cirrhosis. There exists no vaccine against HCV to prevent the occurrence of HCV-related HCC. A sound knowledge of the epidemiology and prevention of the initial infection is vital. The aim of our study was to determine the epidemiologic profile of HCV-related HCC in Cameroon to improve its’ management. Methods It was a prospective study of histologically proven HCV-related HCC seen in two University Centers in Yaounde, Cameroon from March 2012 to January 2013. Demographic data (age, gender), alcohol abuse (>80g/day), presence of cirrhosis, tobacco abuse and parenteral exposition were analyzed. Results Twenty-six patients with histologically proven HCV–related HCC were included (18 men (69.2%) and 8 women (30.8%); mean age +/- SD, 61.46+/-10.18 years). A total of 22 (84.6%) patients had a parenteral exposition, 02 (7.7%) patients were alcoholics and 06 (23.1%) patients were smokers. The proportion of patients with cirrhosis was 69.2% against 30.8% cirrhosis-free. Patients with cirrhosis were relatively younger than those cirrhosis-free (mean age +/- SD, 59.05+/-10.05 years vs 66.87+/- 8.72 years, p=0.06). HCV-related HCC was more prevalent in 60 years and above patients (53.8%, 95%CI: 33.4-73.4). The relative risk of HCC among alcoholics patients was high (RR: 1.5, 95%CI: 1.13-1.99, p<0.05). Conclusion In Cameroon, HCV-related HCC is more prevalent among age older than 60 years, a finding which is relatively less to that found in western countries, male gender is twice more at risk than female gender and cirrhosis frequency is less compared to that observed elsewhere. HCV and alcohol play a synergistic role in the occurrence of HCC in our environment.
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Affiliation(s)
- Firmin Ankouane Andoulo
- Yaounde University Hospital Center, Department of internal medicine and specialties, Faculty of medicine and biomedical sciences, University of Yaounde I, Yaoundé, Cameroon
| | - Dominique Noah Noah
- Yaounde Central Hospital, Department of internal medicine and specialties, Faculty of medicine and pharmaceuticals sciences, University of Douala, Douala, Cameroon
| | - Roger Djapa
- Yaounde University Hospital Center, Department of internal medicine and specialties, Faculty of medicine and biomedical sciences, University of Yaounde I, Yaoundé, Cameroon
| | - Mathurin Kowo
- Yaounde University Hospital Center, Department of internal medicine and specialties, Faculty of medicine and biomedical sciences, University of Yaounde I, Yaoundé, Cameroon
| | - Paul Talla
- Yaounde General Hospital, Department of internal medicine and specialties, Faculty of medicine and biomedical sciences, University of Yaounde I, Yaoundé, Cameroon
| | - Edith Hell Medjo
- Yaounde Central Hospital, Department of Radiology, Faculty of medicine and biomedical sciences, University of Yaounde I, Yaoundé, Cameroon
| | - Isidore Kamsi Djomkam
- Yaounde University Hospital Center, Department of internal medicine and specialties, Faculty of medicine and biomedical sciences, University of Yaounde I, Yaoundé, Cameroon
| | - Bernadette Ngo Nonga
- Yaounde University Hospital Center, Department of surgery and specialties, Faculty of medicine and biomedical sciences, University of Yaounde I, Yaoundé, Cameroon
| | - Oudou Njoya
- Yaounde University Hospital Center, Department of internal medicine and specialties, Faculty of medicine and biomedical sciences, University of Yaounde I, Yaoundé, Cameroon
| | - Elie Claude Ndjitoyap Ndam
- Yaounde General Hospital, Department of internal medicine and specialties, Faculty of medicine and biomedical sciences, University of Yaounde I, Yaoundé, Cameroon
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Ankouane F, Noah DN, Nonga BN, Tagni-Sartre M, Modjo G, Ndam ECN. [Endoscopic resection of colorectal polyps pedicles using a releasable lasso over chrome catgut thread: an alternative to conventional polypectomy? Report of a case series]. Pan Afr Med J 2014; 18:14. [PMID: 25360198 PMCID: PMC4213527 DOI: 10.11604/pamj.2014.18.14.3899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 04/24/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Firmin Ankouane
- Département de Médecine Interne et Spécialités, Faculté de Médecine et des Sciences Biomédicales, Centre Hospitalier et Universitaire de Yaoundé, Université de Yaoundé I, Cameroun
| | - Dominique Noah Noah
- Faculté de Médecine et des Sciences Pharmaceutiques, Université de Douala, Hôpital Central de Yaoundé, Cameroun
| | - Bernadette Ngo Nonga
- Département de Chirurgie et Spécialités, Centre Hospitalier et Universitaire de Yaoundé, Université de Yaoundé I, Cameroun
| | - Michèle Tagni-Sartre
- Service d'Hépato-Gastroentérologie, Centre Médical la Cathédrale, Yaoundé, Cameroun
| | - Gabriel Modjo
- Service d'Hépato-Gastroentérologie, Centre Médical la Cathédrale, Yaoundé, Cameroun
| | - Elie Claude Ndjitoyap Ndam
- Département de Médecine Interne et Spécialités, Hôpital Général de Yaoundé, Université de Yaoundé I, Cameroun
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Weledji EP, Nonga BN. Pseudo-obstruction in the neonate – A difficult diagnosis in a poor-resourced area. Journal of Pediatric Surgery Case Reports 2013. [DOI: 10.1016/j.epsc.2013.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ngo Nonga B, Pasquet A, De Kherkove L, Glineur D, Debieve F, Hubinont C, El khoury G, Noirhomme P. Emergent cardiac surgery with cardiopulmonary bypass in early pregnancy: report of four cases. Res Cardiovasc Med 2013; 2:140-4. [PMID: 25478510 PMCID: PMC4253769 DOI: 10.5812/cardiovascmed.11281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 04/28/2013] [Accepted: 05/01/2013] [Indexed: 11/16/2022] Open
Abstract
Background: Due to current medical improvements, more women with cardiac disease are being operated during pregnancy. Fetal loss has been found to be significant between 9-30% of them and the surgery is supposed to be done maximal in the first trimester. Objectives: The aim of this study was to report our experience with urgent cardiopulmonary bypass carried out in early pregnancy and to analyze factors that may influence fetal and maternal morbidity and mortality after surgery. Materials and Methods: We have retrospectively reviewed the case notes of the patients who underwent cardiac surgery during early pregnancy in our institution from January 1997 to October 2011. Results: During that period cardiac surgery was done in 305 patients in childbearing age (between 15-50 years) from which 4 were pregnant and in the first half of their pregnancy. All of them had previous surgery due to rhumatismal heart disease .The surgery was emergent in 3 cases and urgent in 1 case. They were operated under normothermic conditions, high flow and hemodynamic stability throughout the procedure. There was no fetal loss but one patient sustained a cardiac arrest secondary to asthma complicated by post-anoxic brain injury. Conclusions: Normothermia and hemodynamic stability are the most important factors which help to reduce fetal loss during open heart surgery in pregnancy. The fetus has an auto-regulation which comes into play when the mother is experiencing shock.
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Affiliation(s)
- Bernadette Ngo Nonga
- Service of Thoracic and Cardiovascular Surgery, Department of Cardiovascular Diseases, Brussels’s St Luc University Hospital Center, Brussels, Belgium
- Corresponding author: Bernadette Ngo Nonga, Department of Cardiovascular Diseases, Brussels’s St Luc University Hospital Center. Brussels, Belgium. Tel/Fax: +23-733779597, E-mail:
| | - Agnès Pasquet
- Service of Cardiology, Department of Cardiovascular Diseases, Brussels’s St Luc University Hospital Center, Brussels, Belgium
| | - Laurent De Kherkove
- Service of Thoracic and Cardiovascular Surgery, Department of Cardiovascular Diseases, Brussels’s St Luc University Hospital Center, Brussels, Belgium
| | - David Glineur
- Service of Thoracic and Cardiovascular Surgery, Department of Cardiovascular Diseases, Brussels’s St Luc University Hospital Center, Brussels, Belgium
| | - Frederic Debieve
- Department of Obstetrics and Gynecology, Brussels’s St Luc University Hospital Center, Brussels, Belgium
| | - Corinne Hubinont
- Department of Obstetrics and Gynecology, Brussels’s St Luc University Hospital Center, Brussels, Belgium
| | - Gebrine El khoury
- Service of Thoracic and Cardiovascular Surgery, Department of Cardiovascular Diseases, Brussels’s St Luc University Hospital Center, Brussels, Belgium
| | - Philippe Noirhomme
- Service of Thoracic and Cardiovascular Surgery, Department of Cardiovascular Diseases, Brussels’s St Luc University Hospital Center, Brussels, Belgium
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Nonga BN, Pasquet A, Noirhomme P, El-Khoury G. Successful bovine arch replacement for a type A acute aortic dissection in a pregnant woman with severe haemodynamic compromise. Interact Cardiovasc Thorac Surg 2012; 15:309-10. [PMID: 22547559 DOI: 10.1093/icvts/ivs143] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Acute aortic dissection is very uncommon in pregnant women and the acute type A aortic dissection carries a high mortality rate outside specialized centres. There are a few cases reported with successful outcomes for the mother and the foetus from major cardiac centres. We are reporting our first experience of acute aortic dissection during the third trimester of pregnancy in a patient with Marfan features, profound haemodynamic compromise on arrival and a bovine aortic arch. Both the mother and the baby are doing well two years postoperatively.
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Affiliation(s)
- Bernadette Ngo Nonga
- Department of Cardiovascular and Thoracic Surgery, University Teaching Hospital St Luc, Brussels, Belgium.
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12
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Nonga BN, Jemea B, Tambo FM, Kamgaing N, Bahebeck J, Sosso MA. Feasibility of a simple drainage system in Cameroonian children after thoracotomy and decortication for empyema thoracis. Afr J Paediatr Surg 2012; 9:27-31. [PMID: 22382101 DOI: 10.4103/0189-6725.93298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND To analyse the outcome of children with empyema thoracis treated by decortication followed by a simple drainage system. PATIENTS AND METHODS Retrospective chart review from July 2001 to June 2010 of all cases of children who had a thoracotomy for empyema. We used an endotracheal tube as chest drain and a urinary bag as a collector. Statistical analyses were done using EXCEL and SPSS 9.0. RESULTS Forty one children underwent thoracotomy and decortication for empyema, there were 23 boys and 18 girls with a sex ratio of 1, 21. The mean age was 2½ years with a minimum of 1 month and a maximum of 15 years of age; 27 children were below two years of age. All the patients have received antibiotic for a long period before surgery. The culture was negative, except in two cases where we found Klebsiella pneumonia and Staphylococcus aureus. In five cases, the empyema was due to Mycobacterium tuberculosis. Three children presented a complication: One child had a persistent purulent drainage for 2 weeks; another one was re-operated upon because of necrotic lung abscess and one child died of sepsis. In most cases, the chest tube was removed between day 4 and day 6 post-operatively. The average length of hospital stay after the surgery was 10 days. CONCLUSION Thoracotomy and decortication in children with empyema can be safely done in Cameroon using a simple drainage system with good results compared to those in the literature.
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Ngowe MN, Farikou I, Mouafo Tambo FF, Nonga BN, Andze GO, Sosso MA. The Woodward technique for Sprengel deformation. Surg Tech Dev 2011. [DOI: 10.4081/std.2012.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A case of 5-year-old boy with a left congenital undescended scapula graded Cavendish III was consulted in our unit and operated successfully with the Woodward technique. It was the first case treated by this procedure for the past 10 years, in the Pediatric Surgical Unit of the Yaounde Gyneco-Obstetric and Pediatric Hospital (Cameroon). The Woodward procedure permitted to obtain a good functional and cosmetic result.
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Fokou M, Pagbe JJ, Teyang A, Eyenga VC, Nonga BN, Fongang E, Binam F, Sandmann W. Surgical repair of a giant pseudoaneurysm of the right common carotid artery following a gunshot. Ann Vasc Surg 2010; 25:268.e3-6. [PMID: 20926241 DOI: 10.1016/j.avsg.2010.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Revised: 07/05/2010] [Accepted: 07/23/2010] [Indexed: 10/19/2022]
Abstract
Common carotid pseudoaneurysms are very rare. The authors report a case of a 18-year-old patient with 11 cm large posttraumatic pseudoaneurysm of the right common carotid artery caused by a gunshot in the neck. The patient also had a right hemiplegia, secondary to the left sylvian artery stroke and aphasia. A surgical repair was undertaken with an approach including a total sternotomy. The aneurysm was excluded and a saphenous vein patch was used to repair the 2-cm defect on the arterial wall. The postoperative period was uneventful. This is probably the largest carotid artery aneurysm ever described. The potential hazards of an aneurysm of the common carotid artery indicate that surgical treatment is warranted particularly in a patient with a past history of controlateral stroke.
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Affiliation(s)
- Marcus Fokou
- Department of Surgery, Yaounde General Hospital, Yaounde, Cameroon.
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15
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Bahebeck J, Sobgui E, Loic F, Nonga BN, Mbanya JC, Sosso M, Sosso M. Limb-threatening and life-threatening diabetic extremities: clinical patterns and outcomes in 56 patients. J Foot Ankle Surg 2010; 49:43-6. [PMID: 20123286 DOI: 10.1053/j.jfas.2009.08.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Indexed: 02/03/2023]
Abstract
Limb- and life-threatening hand and foot infections in diabetic patients account for a large proportion of amputations and a substantial number of deaths. Between August 2006 and the end of July 2008, we conducted a prospective cohort study of consecutive diabetic patients with serious hand or foot infections, in an effort to identify clinical patterns and outcomes related to the treatment of these infections. Infections were categorized as dry, gas, and wet gangrene; necrotizing fasciitis or cellulitis; acute extensive osteomyelitis; and any of these infections involving the hand. All of the patients underwent a standard examination and treatment protocol, although none of the patients received vascular surgical care. End points included healing following debridement or minor amputation, major (transtibial or more proximal) amputation, or death. A total of 56 patients were included in the final analyses, and their mean age was 70 (range 51 to 86) years. Of the patients, 17 (30.36%) had necrotizing cellulitis, 12 (21.43%) had wet gangrene, 9 (16.07%) had acute extensive osteomyelitis, 5 (8.93%) had dry gangrene, 5 (8.93%) had gas gangrene, 4 (7.14%) had necrotizing fasciitis, and 4 (7.14) had diffuse hand infections. Five (8.93%) patients died (2 after prior amputation), 26 (46.43%) underwent debridement and/or minor amputation, and 27 (48.21%) required major amputations. Based on our findings, we concluded that 7 patterns of serious limb- or life-threatening infection were identified and, in the absence of vascular surgical intervention, mortality can be reduced at the expense of more amputations.
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Affiliation(s)
- Jean Bahebeck
- Central Hospital of Yaoundé, Faculty of Medicine, University of Yaoundé I, Cameroun.
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Bahebeck J, Atangana R, Mboudou E, Nonga BN, Sosso M, Malonga E. Incidence, case-fatality rate and clinical pattern of firearm injuries in two cities where arm owning is forbidden. Injury 2005; 36:714-7. [PMID: 15910822 DOI: 10.1016/j.injury.2004.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2004] [Revised: 11/01/2004] [Accepted: 11/08/2004] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To review firearm injuries in five hospitals of Douala and Yaounde, both towns of Cameroon, a Sub-Saharan African country where ownership of firearm is forbidden. METHODS This was a retrospective investigation carried out within the period January 1998 to December 2002. Records of the mortuaries, the emergency departments, the intensive care units, the operating rooms and the surgical units were all analysed to identify any injury caused by firearm. Our gold standard was any individual with a clear diagnosis of firearm injury, as determined by a medical doctor. RESULTS 286 firearm injuries were found; 1.14 cases per 100,000 per year. 66% of cases were due to civilian assaults, 20% to armed forces, 8% to hunting accidents and 6% to accidental handling. There was no case of suicide or of shooting from a relative. The type of weapon was unknown in 31% of cases, it was a hand gun in 36%, a hunting type in 21% and an assault rifle in 12%. The mean age of victims was 33 years and the male:female ratio 5.5:1. The site of injury was unknown in 2%; the head in 6%, the chest in 12%, the abdomen in 31%, the extremities in 46%, the spine in 1% and multiple in 2%. The case fatality rate was 12.58%, and the victims were mainly criminals killed by armed forces assaults; the same ratio of survivors developed late complications. CONCLUSION The incidence of firearm injuries in the two largest cities of Cameroon is five to fifty times lower than in many other towns, especially in Western countries. This may be due at least partially, to the current legislation on the ownership of firearm which is very restrictive in this country. Some efforts are however needed to reduce illegal access to weapons and to educate hunters on the safe handling of their gun.
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Affiliation(s)
- Jean Bahebeck
- University Hospital, Surgery and Specialities, BP: 25095 Messa, Yaounde, Cameroun, Cameroon.
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