Digestive surgical emergencies concern all patients admitted urgently, for whom a decision for surgical intervention may be necessary within 24 hours. They are on guard duty day and night. To carry out this work, we s...Digestive surgical emergencies concern all patients admitted urgently, for whom a decision for surgical intervention may be necessary within 24 hours. They are on guard duty day and night. To carry out this work, we set ourselves the objectives of: 1) Studying digestive surgical emergencies in the general surgery department of the “Mother Child” Le Luxembourg hospital in Bamako, Mali;2) Determine the frequency of digestive surgical emergencies, 3) Describe the clinical and therapeutic aspects, and 4) Analyze the results of treatment. From November 1, 2022 to October 31, 2023, the general surgery department of the “Mother Child” Luxembourg Hospital Center in Bamako, Mali, carried out 139 digestive surgical emergencies whose files were usable;75 men and 64 women, a sex ratio of 1.2. The 20 - 40 years old age group was the most represented, at 40.29%. The average age was 39 years;the extremes 16 years and 93 years with a standard deviation of 21.65 years. The reference concerned 51.08% of our patients. Abdominal pain was the main reason for consultation (100% of cases). In the majority of cases, the physical examination made it possible to make the diagnosis. Faced with certain clinical cases, we requested ultrasound (109/139), ASP (46/139) and CT (15/139). The main etiology was acute appendicitis with 42.45% of cases. The frequency of digestive surgical emergencies was 10.71% of all activities in the general surgery department of the “Mère Enfant” Le Luxembourg hospital center in Bamako. All our patients were seen in consultation by an anesthesiologist before entering the operating room. The surgical consequences were complicated in 11.51% of cases with 7.91% deaths. Surgical site infections accounted for 12.5% of postoperative complications. Eleven deaths were noted, representing 68.75% of complications and 7.91% of our sample. Acute peritonitis was the cause of death in 100% of cases. The average cost of care was 329,000 FCFA.展开更多
Introduction:Rheumatic heart disease remains a major public health problem worldwide.African populations pay a heavy price for this condition because of socio-economic and health conditions responsible for delayed dia...Introduction:Rheumatic heart disease remains a major public health problem worldwide.African populations pay a heavy price for this condition because of socio-economic and health conditions responsible for delayed diagnosis,and limited access to cardiac surgery.Objective:To report the morbidity and mortality of a series of patients operated on for rheumatic valvular disease and to compare its correlation with Ambler’s prognostic score.Patients and Methods:Descriptive and analytical study of all patients operated on for rheumatic valvulopathy from 01/01/2019 to 31/12/2021.Results:160 patients were included.The mean age of patients was 23.93.Females predominated at 56.3%.Delay in treatment was between 1 and 3 years in 49.4%of patients.At preoperative assessment,Systolic Pulmonary Arterial Pressure was>60 mmHg in 43.1%of our patients.The mean Ambler score was 6.68,equivalent to a mean risk of peri-operative mortality of 4.1%.Mitral valve replacement was performed in 81.9%;aortic valve replacement in 18.8%.The average extubation time was between 3 and 5 hours in 43.1%of patients.We recorded a perioperative mortality of 6.9%and a late mortality of 8.1%(36 months).Postoperative hemodynamic complications were correlated with the time to management of valve disease:p=0.036;the presence of preoperative PAH was correlated with the post-operative occurrence of respiratory complications:p=0.029;the presence of preoperative complete arrhythmia due to atrial fibrillation(CAF)was correlated with the post-operative occurrence of renal failure p=0.017.There was no correlation between Ambler score and peri-operative mortality in our series.Conclusion:Cardiac surgery faces many difficulties in sub-Saharan Africa.Risk stratification scores in cardiac surgery are not adapted.The establishment of a pan-African exchange network would be a way of improving this surgical practice in our countries.展开更多
Introduction:Pulmonary hypertension(PH)is a hemodynamic and pathophysiological condition characterized by abnormally elevated pressures in the pulmonary vasculature.It is defined by a mean pulmonary arterial pressure...Introduction:Pulmonary hypertension(PH)is a hemodynamic and pathophysiological condition characterized by abnormally elevated pressures in the pulmonary vasculature.It is defined by a mean pulmonary arterial pressure≥25 mmHg at rest by right heart catheterization.He is frequently associated with cardiovascular surgery and is a common complication that has been observed after surgery utilizing cardiopulmonary bypass(CPB).Preoperative PH has been significantly linked to morbidity and is a risk factor for poor outcome post-surgery.Some specific features in sub-Saharan Africa:given the lack of access to cardiac surgery,PAH occurs very frequently in cases of advanced heart disease in patients with congenital heart disease or rheumatic valve disease that has been treated late.Objective:The purpose of this study was to evaluate a protocol for managing PH during cardiac surgery under cardiopulmonary bypass in resource limited settings.Patients and Methods:This is a descriptive and analytical retrospective study that included all patients who underwent cardiopulmonary bypass surgery at the“Le Luxembourg”Mother and Child University Hospital between January 1,2023,and June 30,2024,and who had a preoperative systolic pulmonary artery pressure(SPAP)≥35 mmHg.Preoperatively,all patients included were given Furosemide:1 mg/kg and Sildenafil 5 or 10 mg/8 hours in children and 20 mg/8 hours in adults.In the operating room,a nasogastric tube was inserted to administer sildenafil at the end of surgery,and weaning from CPB was performed using Milrinone at a syringe pump rate of 5μg/kg/min,combined with Norepinephrine as needed depending on hemodynamic status.We analyzed the mean changes in PAPS from the preoperative assessment to discharge from intensive care.Results:During the period,292 patients underwent surgery,142 of whom had PH,representing a prevalence of 48.63%.Our patients had an average age of 11.57±11.There was a female predominance of 51.4%.The average length of preoperative hospitalization was 5 days[3-8].The time between diagnosis and surgical treatment was between 1 and 5 years in 62.8% of cases.It was≤1 year in 29.6%of cases.The clinical signs were dominated by dyspnea in 43.7% of cases.Pulmonary artery systolic pressure was between 51-100 mmHg in 29.58% and>100 mmHg in 19.72% of cases,with a mean preoperative sPAP of 59 mmHg[35-110].Congenital heart disease accounted for 52.11% of surgical indications,and valvular heart disease for 47.89%.Surgical indications for mitral valve disease accounted for 35.92% of cases and those for congenital heart disease for 52.11%.The mean duration of CPB was 110 min±50.There were no intraoperative episodes of pulmonary hypertension.At the end of surgery,the average time to postoperative extubation in intensive care was 3.53 hours±2.2.There was a significant decrease in sPAP between the preoperative and postoperative periods.A comparison of pre-and post-operative sPAP averages using a t-test was significant with a P-value<0.001(t:27.978).The main postoperative complications are:Overall cardiac failure:4.2%;respiratory failure:2.1%;hematological complications:0.7%.We recorded a perioperative mortality rate of 5.6%.Conclusion:PH complicates rheumatic valve disease and certain congenital heart diseases.It is common in our resourcelimited setting,where access to cardiac surgery is insufficient.It is associated with high perioperative morbidity and mortality.Management is well codified,but the therapeutic classes are sometimes unavailable in our countries.The postoperative protocol of furosemide+sildenafil and milrinone appears to give good results.展开更多
文摘Digestive surgical emergencies concern all patients admitted urgently, for whom a decision for surgical intervention may be necessary within 24 hours. They are on guard duty day and night. To carry out this work, we set ourselves the objectives of: 1) Studying digestive surgical emergencies in the general surgery department of the “Mother Child” Le Luxembourg hospital in Bamako, Mali;2) Determine the frequency of digestive surgical emergencies, 3) Describe the clinical and therapeutic aspects, and 4) Analyze the results of treatment. From November 1, 2022 to October 31, 2023, the general surgery department of the “Mother Child” Luxembourg Hospital Center in Bamako, Mali, carried out 139 digestive surgical emergencies whose files were usable;75 men and 64 women, a sex ratio of 1.2. The 20 - 40 years old age group was the most represented, at 40.29%. The average age was 39 years;the extremes 16 years and 93 years with a standard deviation of 21.65 years. The reference concerned 51.08% of our patients. Abdominal pain was the main reason for consultation (100% of cases). In the majority of cases, the physical examination made it possible to make the diagnosis. Faced with certain clinical cases, we requested ultrasound (109/139), ASP (46/139) and CT (15/139). The main etiology was acute appendicitis with 42.45% of cases. The frequency of digestive surgical emergencies was 10.71% of all activities in the general surgery department of the “Mère Enfant” Le Luxembourg hospital center in Bamako. All our patients were seen in consultation by an anesthesiologist before entering the operating room. The surgical consequences were complicated in 11.51% of cases with 7.91% deaths. Surgical site infections accounted for 12.5% of postoperative complications. Eleven deaths were noted, representing 68.75% of complications and 7.91% of our sample. Acute peritonitis was the cause of death in 100% of cases. The average cost of care was 329,000 FCFA.
文摘Introduction:Rheumatic heart disease remains a major public health problem worldwide.African populations pay a heavy price for this condition because of socio-economic and health conditions responsible for delayed diagnosis,and limited access to cardiac surgery.Objective:To report the morbidity and mortality of a series of patients operated on for rheumatic valvular disease and to compare its correlation with Ambler’s prognostic score.Patients and Methods:Descriptive and analytical study of all patients operated on for rheumatic valvulopathy from 01/01/2019 to 31/12/2021.Results:160 patients were included.The mean age of patients was 23.93.Females predominated at 56.3%.Delay in treatment was between 1 and 3 years in 49.4%of patients.At preoperative assessment,Systolic Pulmonary Arterial Pressure was>60 mmHg in 43.1%of our patients.The mean Ambler score was 6.68,equivalent to a mean risk of peri-operative mortality of 4.1%.Mitral valve replacement was performed in 81.9%;aortic valve replacement in 18.8%.The average extubation time was between 3 and 5 hours in 43.1%of patients.We recorded a perioperative mortality of 6.9%and a late mortality of 8.1%(36 months).Postoperative hemodynamic complications were correlated with the time to management of valve disease:p=0.036;the presence of preoperative PAH was correlated with the post-operative occurrence of respiratory complications:p=0.029;the presence of preoperative complete arrhythmia due to atrial fibrillation(CAF)was correlated with the post-operative occurrence of renal failure p=0.017.There was no correlation between Ambler score and peri-operative mortality in our series.Conclusion:Cardiac surgery faces many difficulties in sub-Saharan Africa.Risk stratification scores in cardiac surgery are not adapted.The establishment of a pan-African exchange network would be a way of improving this surgical practice in our countries.
文摘Introduction:Pulmonary hypertension(PH)is a hemodynamic and pathophysiological condition characterized by abnormally elevated pressures in the pulmonary vasculature.It is defined by a mean pulmonary arterial pressure≥25 mmHg at rest by right heart catheterization.He is frequently associated with cardiovascular surgery and is a common complication that has been observed after surgery utilizing cardiopulmonary bypass(CPB).Preoperative PH has been significantly linked to morbidity and is a risk factor for poor outcome post-surgery.Some specific features in sub-Saharan Africa:given the lack of access to cardiac surgery,PAH occurs very frequently in cases of advanced heart disease in patients with congenital heart disease or rheumatic valve disease that has been treated late.Objective:The purpose of this study was to evaluate a protocol for managing PH during cardiac surgery under cardiopulmonary bypass in resource limited settings.Patients and Methods:This is a descriptive and analytical retrospective study that included all patients who underwent cardiopulmonary bypass surgery at the“Le Luxembourg”Mother and Child University Hospital between January 1,2023,and June 30,2024,and who had a preoperative systolic pulmonary artery pressure(SPAP)≥35 mmHg.Preoperatively,all patients included were given Furosemide:1 mg/kg and Sildenafil 5 or 10 mg/8 hours in children and 20 mg/8 hours in adults.In the operating room,a nasogastric tube was inserted to administer sildenafil at the end of surgery,and weaning from CPB was performed using Milrinone at a syringe pump rate of 5μg/kg/min,combined with Norepinephrine as needed depending on hemodynamic status.We analyzed the mean changes in PAPS from the preoperative assessment to discharge from intensive care.Results:During the period,292 patients underwent surgery,142 of whom had PH,representing a prevalence of 48.63%.Our patients had an average age of 11.57±11.There was a female predominance of 51.4%.The average length of preoperative hospitalization was 5 days[3-8].The time between diagnosis and surgical treatment was between 1 and 5 years in 62.8% of cases.It was≤1 year in 29.6%of cases.The clinical signs were dominated by dyspnea in 43.7% of cases.Pulmonary artery systolic pressure was between 51-100 mmHg in 29.58% and>100 mmHg in 19.72% of cases,with a mean preoperative sPAP of 59 mmHg[35-110].Congenital heart disease accounted for 52.11% of surgical indications,and valvular heart disease for 47.89%.Surgical indications for mitral valve disease accounted for 35.92% of cases and those for congenital heart disease for 52.11%.The mean duration of CPB was 110 min±50.There were no intraoperative episodes of pulmonary hypertension.At the end of surgery,the average time to postoperative extubation in intensive care was 3.53 hours±2.2.There was a significant decrease in sPAP between the preoperative and postoperative periods.A comparison of pre-and post-operative sPAP averages using a t-test was significant with a P-value<0.001(t:27.978).The main postoperative complications are:Overall cardiac failure:4.2%;respiratory failure:2.1%;hematological complications:0.7%.We recorded a perioperative mortality rate of 5.6%.Conclusion:PH complicates rheumatic valve disease and certain congenital heart diseases.It is common in our resourcelimited setting,where access to cardiac surgery is insufficient.It is associated with high perioperative morbidity and mortality.Management is well codified,but the therapeutic classes are sometimes unavailable in our countries.The postoperative protocol of furosemide+sildenafil and milrinone appears to give good results.
