Ma Sosso

Implant orthopaedic surgery in HIV asymptomatic carriers: management and early outcome.

BACKGROUNDnTo the best of our knowledge, no reports currently exist on how to manage HIV infected patients in cases where they present with an absolute indication for implant surgery. The aim of this study was to compare the immediate and early outcome of implant orthopaedic surgery in HIV carriers with less than 500CD4/ml (group A) treated with a protective antiretroviral therapy and prolonged prophylactic antibiotic therapy in one group, and in the other group, HIV carriers with more than 500CD4/ml (group B) and non-HIV carriers (group C) treated conventionally.nnnMETHODSnDuring a 36-month-period, a protocol of screening and subsequent management of HIV carriage was proposed to patients admitted for internal clean trauma or orthopaedic implant surgery in our department. The HIV screening, its confirmation and the CD4 count were carried out by conventional methods. All group A patients were treated with cefuroxime for 10 days and a fixed combination of antiretroviral tritherapy before or just after surgery. Group B and C patients solely underwent surgery with a conventional 1.5g of cefuroxime. The wounds in the three groups were later examined at days 2, 7, 14, 45 and at 3 months. The rates of clinical wound infection were compared using the Fisher exact test; the difference was considered significant if p<or=0.05.nnnRESULTSnSix hundred and forty-six patients were selected for this protocol, due to fresh fractures in 544 (84.21%) cases, non-union in 41 (6.34%), mal-union in 17 (2.63%), aseptic necrosis in 16 (2.47%) and osteoarthritis in 28 (4.33%). During surgery, IM nailing was performed in 351 (54.33%) patients, plating in 165 (25.54%), pinning or wiring in 31 (4.79%) and finally, arthroplasty in 99 (15.32%) among which 45 were total hip replacements. Regarding HIV carriage and immune status, 44 patients were of group A, 30 of group B and 572 of group C. Two cases of infection were observed in both group A (4.54%) and group B (6.66%), and 37 in group C (6.46%). The differences were statistically non-significant.nnnCONCLUSIONSnThe authors conclude that if a prolonged prophylactic antibiotic therapy and systematic antiretroviral therapy are given to HIV immune-depressed carriers undergoing implant orthopaedic surgery, their post-operative infection risk may be close to that of non-HIV carriers.

Our experience in the management of infantile hydrocephalus: A study on thirty-five regrouped cases in Yaounde, Cameroon

BACKGROUNDnHydrocephalus is a frequent central nervous system disorder in children, and despite its importance, it has not been sufficiently studied in developing countries.nnnPATIENTS AND METHODSnA prospective and descriptive study on 35 cases of infantile hydrocephalus was carried out in the neurosurgery unit of the Yaounde Central Hospital, from March 2008 to January 2010.nnnRESULTSnThe mean age of the patients was 6.69±1.58 months, and the majority of them were in the 0-6 months age group (71.43%). The most frequent causes were congenital malformations, with stenosis of the aqueduct of Sylvius being the most represented (31.43%). As radiological workup, a CT scan was done in more than half of the cases (57.15%), and ventriculo-peritoneal shunting was the main surgical method of management used (94.29%). Infectious complications were observed in 22.86% of our cases.nnnCONCLUSIONnHydrocephalus is a frequent disorder in this Cameroonian setting affecting mostly the 0-6 months age group. For early diagnosis to be made, the head circumference of neonates should be routinely measured in the labour room and followed-up in all medical visits. To avert complications following surgery, rigorous surgical procedures with effective asepsis and appropriate methods and materials for shunting should be used.

The role of surgery in the management of Pott's disease in Yaoundé. A review of 43 cases.

INTRODUCTIONnPotts disease is a common entity in our hospital. The authors report their experience in the surgical treatment of Pott disease.nnnPATIENTS AND METHODSnThis is a retrospective study including all patients who underwent surgery for Potts disease in our institution between November 1999 and November 2004.nnnRESULTSnForty-three patients were included, including 23 men and 20 women (ratio 1.15). Location of the disease was cervical (2 cases), dorsal (19 cases), dorsolumbar (2 cases) lumbar (16 cases) and sacrolumbar (4 cases). Ten patients were HIV positive (24%). The surgical indication was sometimes diagnostic, but predominantly therapeutic (medullary compression, instability or deformity). Spinal decompression alone was performed in 23 cases, associated with internal fixation of the spine (17 cases) or external immobilization (Halo Vest) in two cases. The anterior approach was used in four cases and a posterior approach in 38 cases. Decompression by posterior approach included 1 or 2 level laminectomy alone or associated with internal plate fixation (4 pedicle screws and 2 plates). There was no functional recovery in patients with a complete neurological deficit (Frankel A); those with a severe deficit (Frankel B) partially recovered, while those with more moderate deficits (Frankel C and D) recovered completely. Fusion was obtained (graft integration) regardless of the surgical approach used, progression of the deformity was stopped and early mobilization was possible.nnnCONCLUSIONnSurgery definitely plays a role in the diagnosis and treatment of Potts disease, especially in countries where patients are seen at a late stage of the disease when complications have developed. Surgical decompression should not be delayed until lesions become ischemic and irreversible (Frankel A).nnnLEVEL OF EVIDENCEnLevel IV. Retrospective study.

Association of Inconclusive Sera for Human Immunodeficiency Virus Infection with Malaria and Epstein-Barr Virus Infection in Central Africa

ABSTRACT 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.

Séroprévalence et facteurs associés au VIH et aux hépatites virales B et C dans la ville de Bafoussam au Cameroun

Introduction Lobjectif de ce travail était de déterminer la séroprévalence et les facteurs associés au VIH et aux hépatites virales B et C dans la ville de Bafoussam au Cameroun. Méthodes Il sagissait dune étude descriptive et analytique réalisée de février 2012 à Juin 2012 dans la ville de Bafoussam au Cameroun. Pour cette étude, nous avons obtenu une clairance éthique. Résultats Au total, 982 personnes ont été dépistées pour le VIH et les hépatites virales B et C. Les femmes représentaient 56,3% des personnes dépistées. La tranche d’âge la plus représentée était celle des 20 à 24 ans. L’âge médian était de 34,5 ans. Les prévalences du VIH, de lAgHBs, et de lAc anti HCV étaient respectivement de 6,0%, 4,1%, et 0,4%. La prévalence du VIH était 2 fois plus élevée parmi les femmes que les hommes avec 8,1% contre 3,5% (p=0,01). Les prévalences les plus élevées ont été observées chez les personnes de 30 à 34 ans, 40 à 44 ans avec 15,0% et 11,5% (p=0,01), les personnes sans emploi avec 11,1% (p<0,001) et les personnes en union libre avec 17,9% (p=0,000). La prévalence du VIH n’était pas directement liée aux comportements et pratiques sexuels de la population de l’étude. On enregistrait une prévalence élevée de 29,3% chez les individus ayant déclaré avoir au moins une infection sexuellement transmissible (p=0,000). Conclusion Il apparait urgent de mettre en place des stratégies de prévention contre le VIH, les hépatites virales et les facteurs associés au Cameroun.

Anterior approach in humeral plating osteosynthesis

CONTEXTnHumeral 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.nnnHYPOTHESISnThe 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.nnnMATERIALS AND METHODSnA 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.nnnRESULTSnThe 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).nnnCONCLUSIONnCameroon 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.

Our experience of proximal hypospadias repair using the Cloutier-Bracka technique at the Gynaeco-Obstetric and Paediatric Hospital, Yaounde-Cameroon.

Background: In parts of Africa, routine circumcision is practised and sometimes even on children with hypospadias. The lack of preputial foreskin renders urethroplasty more difficult and often requires to use of a mucosal graft as described by Bracka. Objective: The authors describe their experience of hypospadias repair using Brackas technique. Materials and Methods: Over a period of 5 years, 100 cases of proximal hypospadias were operated in our institution. All patients aged 0–18 years who had already been circumcised were included in this study. Results: The outcome of the 12 cases operated according to Brackas technique was analysed. The mean age was 11.5 years. The ectopic meatus was penoscrotal in three cases, scrotal in one case and perineal in eight cases. After reconstruction, the new meatus was sutured at the top of the glans in one case, at the prepuce in seven cases and at the penile midshaft in one case. The main complications noted were surgical site infection, wound dehiscence, residual chordee and urethrocutaneous fistula. No neourethral stenosis nor uretrocele was recorded. Discussion: The buccal mucosal graft urethroplasty as described by Bracka is associated with a lower risk of meatal strictures compared to other free mucosal grafts. The buccal mucosa is easier to harvest and causes less scarring than bladder mucosa. Conclusion: Repair of severe hypospadias remains a challenge for paediatric surgeons. The functional and cosmetic outcomes depend on the choice of the donor site for the graft and objective assessment of successful reconstruction criteria during follow-up.

Preliminary study of laparoscopic cholecystectomy in Cameroon

AIMnThe purpose of this study was to evaluate the feasibility of laparoscopic cholecystectomy in Cameroon.nnnMATERIALS AND METHODnThis retrospective study includes all patients who underwent laparoscopic cholecystectomy in three major hospitals in Cameroon from 2001 to 2009. Charts were reviewed for epidemiological data, complications, and outcome.nnnRESULTSnThis study included 52 patients. Their mean age was 45 years (range: 17-71). All had symptomatic gallstones, and 15 presented acute cholecystitis. The rate of conversion to open surgery was 7.7%. No deaths occurred. One patient required reoperation due to cystic duct stump leakage complicated by biliary peritonitis. The average duration of hospitalization was 3 days.nnnCONCLUSIONnBased on these results, we recommend laparoscopic cholecystectomy for symptomatic gallstones in Cameroon.

Aspects diagnostiques et thérapeutiques des déformations d’axe des membres inférieurs de l’enfant africain. Revue de 43 cas.

La description des aspects cliniques des deformations d’axe des membres inferieurs de l’enfant interesse de plus en plus, les auteurs africains. Toutefois, leur prise en charge therapeutique et notamment le volet chirurgical merite d’etre mieux codifiee. L’etude retrospective de juillet 1998 a decembre 2003, dans deux services d’Orthopedie-Traumatologie de Yaounde et Douala avait pour but de degager les aspects diagnostiques et therapeutiques de ces affections dans notre contexte. Elle a porte sur les dossiers medicaux des enfants operes pour deformations d’axe des membres inferieurs. Pour chaque patient, le diagnostic etait radio-clinique et l’essentiel du geste chirurgical represente par les osteotomies tibiales et ou femorales cuneiformes et les epiphysiodeses par agrafage. Quarante trois dossiers ont ete colliges parmi lesquels 31 filles et 12 garcons, soit un sex ratio de 0,3. L’âge moyen de nos patients etait de 9,5 ans. Trente huit pour cent et demi des patients presentaient une deviation angulaire superieure ou egale a 45°. Soixante dix osteotomies cuneiformes et 3 epiphysiodeses par agrafage etaient realisees. Le taux de complication etait de 0,6 par genou opere. La chirurgie est une methode efficace pour traiter les deformations d’axe des membres inferieurs dans leurs formes severes, frequentes en Afrique.

Particularités épidémiologiques, diagnostiques et thérapeutiques de la hernie ombilicale de l’enfant noir africain.

D’avril 2004 a fevrier 2011 une etude retrospective et prospective portant sur 75 cas de hernies ombilicales a ete menee dans le service de chirurgie pediatrique de l’Hopital Gyneco-Obstetrique et Pediatrique de Yaounde (HGOPY). L’âge moyen des patients etait de 3 ans et la predominance masculine etait remarquee avec un sex ratio de 1,5. La presentation clinique etait dominee par les engouements et etranglements herniaires, representant respectivement 58,6% et 14,6% des cas. Les auteurs soulignent les particularites epidemio-cliniques des hernies ombilicales de l’enfant noir africain et font un plaidoyer pour la chirurgie systematique dans ce contexte, devant toute hernie ombilicale meme non compliquee, surtout devant un diametre du collet reduit (≤1,5 cm) chez le nourrisson de sexe masculin. Mots cles : Hernie ombilicale, epidemiologie, diagnostic, traitement, Afrique.