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Clinical Epidemiology and Surgical Treatment of Spontaneous Perforations of the Terminal Ileum: A Multicentre Study in Cameroon

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Surgical Science 2024年第5期15卷 311-320页

作者： Eric Patrick Savom Richard II Mbele Mahamat Yannick Ekani Boukar Abdal Deudeu Cédric Paterson Atangana fred dikongue dikongue Guy Aristide Bang Marc Leroy Guifo Yaoundé General Hospital Yaound&#233 Cameroon Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I Yaoundé Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Faculty of Medicine and Biomedical Sciences of the University of Dschang Dschang Cameroon Yaoundé Teaching Hospital Yaoundé Cameroon

Background: Perforations of the terminal ileum are a frequent clinical situation and a therapeutic challenge. Surgical treatment is controversial. Several surgical modalities have been proposed and postoperative morbidity and mortality remain high. The aim of this study was to review our experience in the surgical management of perforations of the terminal ileum. Patients and methods: This is a descriptive cross-sectional study with retrospective data collection from January 1, 2017 to December 31, 2021, in five hospitals in Cameroon. Patients’ demographic, clinical presentation, surgical findings and 30-days postoperative outcomes data were collected. Results: We collected 34 files. The sex ratio was 1.4 and the average age was 20.28 years. The average consultation time was 9.1 days. Abdominal pain was present in all our patients. Peritoneal irritation was present in 46 cases (88.5%). The mean time to treatment after admission was 17.5 hours. The perforation was unique in 40 cases (76.9%) and located between 6 and 10 cm from the ileocecal valve in 29 cases (55.8%). Typhoid was the most suspected etiology intraoperatively in 38 cases (73.1%). A simple suture was performed in 18 patients (34.6%), resection with anastomosis in 11 patients (21.2%) and an ileostomy in 5 patients (9.6%). The average length of hospitalization was 21.74 days. Postoperative morbidity and mortality were 32.7% and 17.3% respectively. Conclusion: Perforations of the terminal ileum are common and affect young people. Surgical procedures are varied. Reducing consultation and care times and respecting treatment principles could improve postoperative morbidity and mortality, which remain high.

关键词： Perforation of the Terminal Ileum Simple Suture Resection Morbidity Mortality

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Results of Surgical Management of Malignant Obstruction of the Common Bile Duct in Yaoundé

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Surgical Science 2024年第4期15卷 265-277页

作者： Eric Patrick Savom Gaël Tsanga Nomo Richard II Mbele Mahamat Yannick Ekani Boukar Cédric Paterson Atangana fred dikongue dikongue Guy Aristide Bang Arthur Essomba Yaoundé General Hospital Yaound&#233 Cameroon Faculty of Medicine and Biomedical Sciences of the Universityof Yaoundé I Yaound&#233 Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Faculty of Medicine and Biomedical Sciences of the University of Dschang Dschang Cameroon Yaoundé Teaching Hospital Yaound&#233 Cameroon

Introduction: In Cameroon, surgery remains the only approach in malignant obstructions of the common bile duct (MOCBD) even in palliative situations. The aim of this work was to describe the modalities of surgical treatment of MOCBD, evaluate the results and detect the factors associated with postoperative morbidity and mortality. Patients and Methods: We conducted an analytical observational study, with retrospective data collection from the files of patients operated upon for MOCBD. This was done in four referral hospitals in the city of Yaoundé for a 42-month period spanning from January 1, 2020 to June 30, 2023. Demographic data, clinical presentation, surgical data, and 30-day postoperative outcomes were collected. Results: We collected 71 files. The sex ratio was 1.4 and the mean age was 56 ± 11 years. Fifty-three (53) patients (74.6%) were overweight or obese and 10 patients (14.1%) were hypertensive. A clinical cholestasis syndrome was present in 69 patients (97.2%). Fifty-five (55) patients (77.5%) had a cancer of the head of the pancreas, 8 patients (11.3%) had an extra-hepatic cholangiocarcinoma and 8 patients (11.3%) had an ampullary adenocarcinoma. Eight (8) resections (11.3%) with curative intent had been carried out and in 63 cases (88.7%), surgery was palliative. Postoperative morbidity was 55.7%, influenced by advanced WHO stage (p = 0.02). Postoperative mortality was 25.7%, associated with a high ASA score (p = 0.01). Conclusion: Pancreatic head cancer is the main etiology of malignant obstructions of the common bile duct in Cameroon. Surgical treatment is most often palliative. Postoperative morbidity and mortality are high, influenced by high WHO and ASA scores.

关键词： Malignant Obstruction Common Bile Duct Palliative Treatment Morbidity Mortality

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Surgical Management of Perforated Colon Tumours in Yaoundé: A Multicentre Retrospective Review of 30-Day Postoperative Outcome

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Surgical Science 2024年第5期15卷 330-341页

作者： Eric Patrick Savom Richard II Mbele Colman Tamboh Tankou Mahamat Yannick Ekani Boukar Cédric Paterson Atangana fred dikongue dikongue Daniel Biwole Biwole Guy Aristide Bang Arthur Essomba Yaoundé General Hospital Yaound&#233 Cameroon Faculty of Medicine and Biomedical Sciences University of Yaound&#233 I Yaound&#233 Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Faculty of Medicine and Biomedical Sciences University of Dschang Dschang Cameroon Yaoundé Central Hospital Yaound&#233 Cameroon Yaoundé University Teaching Hospital Yaound&#233 Cameroon

Introduction: Colon cancer is often diagnosed late in our context and there is a high prevalence of complicated forms, this including perforation. The optimal surgical treatment remains controversial. The aim of this study was to improve the short-term postoperative outcomes of patients operated upon for perforated colon cancer, by identifying factors associated with complications occurring within 30 days after surgery. Patients and methods: We carried out an analytical observational study, with a retrospective collection of data from the files of patients operated upon for an in situ tumoral colon perforation. This was done in four referral hospitals in the city of Yaoundé. The period was from the 1st of January, 2012 to the 31st of December, 2021. Cox regression identified the factors associated with postoperative morbidity and mortality. Results: We collected files of 46 patients. The mean age was 54.7 ± 19.9 years with a sex ratio of 1.4. The clinical presentation on admission was dominated by the presence of signs of peritoneal irritation (91.3%) and bowel obstruction (28.3%). The diagnosis was made preoperatively in 16 cases (34.8%). The surgical procedures consisted of colectomy with anastomosis in 28 cases (60.9%) and without anastomosis in 14 cases (30.4%). Postoperative morbidity was 60.9% dominated by surgical site infection (37%). Postoperative mortality was 39.1%. The existence of generalized peritonitis was associated with the occurrence of postoperative complications (p = 0.019). The main factors associated with postoperative mortality were resection with primary anastomosis (p = 0.027), enterocutaneous fistula (p = 0.005). Conclusion: Colic resection with primary anastomosis or ideal colectomy is associated with an increased risk of mortality and should therefore not be performed in this setting.

关键词： Perforated Colon Cancer Postoperative Morbidity and Mortality Colectomy Acute Generalized Peritonitis

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Laparoscopic Surgery of Incisional Hernia: Technique and Short-Term Results in Three Surgical Units in Cameroon

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Surgical Science 2024年第4期15卷 232-243页

作者： Guy Aristide Bang Eric Patrick Savom Achille Aimé Bekolo Otiti fred dikongue dikongue Mahamat Yannick Ekani Boukar Richard II Mbele Cédric Paterson Atangana Daniel Biwole Biwole Arthur Essomba Yaoundé Teaching Hospital Yaound&#233 Cameroon Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I Yaound&#233 Cameroon Yaoundé General Hospital Yaound&#233 Cameroon Faculty of Medicine and Biomedical Sciences of the University of Dschang Dschang Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Yaoundé Central Hospital Yaound&#233 Cameroon

Introduction: Incisional hernia is a common medical situation and its treatment has always been a challenge for general surgeons. If laparoscopic repair has become a gold standard elsewhere, it is increasingly done in our milieu, but no data has been found. The aim of this study was to review this surgery done in our country so far, to describe the operative technique and to evaluate the postoperative outcomes. Patients and Methods: We conducted an observational descriptive study with retrospective collection of data from the 1st of July 2018 to 30th of June 2022, in three hospitals in Cameroon. Data on socio-demographic and clinical characteristics, surgical technique and postoperative outcomes of patients who had a laparoscopic repair of their incisional hernia were collected. Results: We reviewed 20 files. There were 14 women with an average age of 54.6 years. The average BMI was 32.8 kg/m2. Thirteen patients had a moderate size hernia and the hernia was localized at the midline in 18 cases. Only composite biface meshes were used with dimensions chosen to obtain at least 5 cm overlap. Spiral tacks were the only fixation means used. We registered 3 complications. One case of generalized peritonitis secondary to missed digestive perforation, one case of seroma and one case of postoperative ileus. We registered no death. Conclusion: Laparoscopic repair of incisional hernias is feasible in a resource-limited setting like ours. Compliance with the operative technique and recommendations is important to obtain short-term results closed to that put forward by literature.

关键词： Incisional Hernia Laparoscopy Repair Composite Biface Mesh Postoperative Outcomes

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Scrotal Trauma in a Motorcycle Accident Leading to a Partial Orchidectomy: Case Report

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Open Journal of Urology 2023年第12期13卷 559-564页

作者： Tiéoulé Mamadou Traore Stéphane Kohpe Kapseu fred dikongue dikongue Centre Hospitalier Universitaire de Ouahigouya Université Ouahigouya/UFRSS Ouahigouya Burkina Faso Cliniques Universitaires des Montagnes Surgery Department Université des Montagnes Bangangté Cameroon Département de Chirurgie et Spécialités Faculté de Médecine et des Sciences Pharmaceutiques Université de Dschang Dschang Cameroon

Scrotal trauma in motorcycle accidents (STMA) is a rare entity in the literature. In general, trauma to the genitals is not life-threatening. However, STMA can cause rupture of the testis with consequences that can lead to alteration of sexuality and reproduction. We present an STMA case managed in a rural hospital where various types of injuries arise from motorcycle accidents. A 20-year-old man without any previous pathology presented in our hospital with a swollen painful scrotum. One week prior to presentation, the patient with a speeding motorbike drove over a speed bump, and the frame of his motorcycle broke into two halves, violently striking his genitals and causing scrotal trauma. After examination and investigation, patient has consented to scrotal exploration which was carried out. A partial left orchidectomy was performed and the right testicle was healthy. The evolution was favorable and the patient was discharged on the 5th postoperative day. Prognosis at 6 months was good. It is possible that genital trauma related to motorcycle accidents will become more frequent in the future. This underscores the importance of educating motorcyclists to respect the Highway Code;and making practitioners aware of the risk of serious injury in the event of acute scrotal trauma.

关键词： Scrotal Trauma Motorcycle Accident Orchidectomy Case Report

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Partial Amputation of the Penis with Total Rupture of the Urethra: About a Case in the Urology Department of the Bonamoussadi District Medical Center

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Surgical Science 2023年第7期14卷 496-501页

作者： fred dikongue dikongue Boris Amougou Omam Merlin Mbamba Fondop Joseph Faustin Atemkeng Chichom Mefire Alain Department of Surgery and Specialties Faculty of Medicine and Pharmaceutical Sciences University of Dschang Dschang Cameroon Bonamoussadi District Medical Center Douala Cameroon Yaoundé Emergency Center Yaoundé Cameroon Faculty of Health Science University of Buea Buea Cameroon

Penis amputations are rare, they are most often observed in a criminal context or in the context of self-mutilation. We present the case of a partial amputation of the shaft in the context of a domestic accident. This is a 53-year-old patient received in the emergency department for partial amputation of the penis occurred, whose mechanism of occurrence would be the fall of a sheet metal from the roof of his house, with reception on the proximal end of the shaft leading to a partial rupture of it—here, with total urethral section. He has no medical-surgical history. The physical examination finds a good general condition, a partial tearing of the ventral face of the penis associated with a total rupture of the urethra followed by a hemorrhage, the rest of the examination was without particularity. The emergency assessment carried out was without particularity. The treatment consisted initially of catheterizing the urethra by a urinary tube ch 20, then a urethral replacement, followed by a Peno plastie. The surgical suites were enamelled with parietal suppuration plus necrosis at J 14 post-operative. A more bidaily dressing debridement followed with a favorable evolution at 2 months. Subsequently, a penile graft was performed more urethrolastic, with removal of the flap on the inner side of the thigh, the surgical suites were favorable on the sexual plane gradual resumption of night erections.

关键词： Penis Partial Amputation Uretroplasty Penoplasty Flap Bonamoussadi Subdivisional Health Center

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Assessment of the 2 Conventional Physiotherapy Sessions Alone versus One Session Associated to Kabat’s Method in the Rehabilitation of Buruli Ulcer Patients (PUB), with Functional Limitations in the District Hospital of Akonolinga, Cameroon

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Surgical Science 2023年第6期14卷 428-435页

作者： fred dikongue dikongue Faustin Tsatedem Atemkeng Joseph Fondop Jean Hubert Donfack Alain Djam Nkomo Banga Mbida Mpoame Faculty of Medicine and Pharmaceutical Sciences University of Dschang Dschang Cameroon

Buruli ulcer (BU) is a chronic, indolent necrotizing disease of the skin and underlying tissues caused by Mycobacterium ulcerans, which may result in functional disability. This disease is the third most frequent infection after leprosy and tuberculosis caused by a mycobacterium. The main objective of this study was to determine comparative effectiveness of conventional physiotherapy alone to its association with Kabat’s method in the management of post-Buruli ulcer functional limitations. This was an interventional randomized, comparative and prospective study. It took place at the district hospital of Akonolinga from the 12th June to 12th September 2016. The study was included, post-Buruli ulcer patients who matched the eligibility criteria, were under treatment in the physiotherapy unit, and who accepted to participate in our study. A questionnaire on the socio-demographic profile of participants, the ulcer localization, the limitation stage, previous medical history and functional mobility assessment scale was administered to the subjects before and after the intervention which lasted for twelve weeks. We had 2 groups: the case group received association of Kabat technique to conventional physiotherapy and the control group received conventional physiotherapy alone. We had 22 patients, 11 patients for the experimental group, 11 patients for the control group. The mean age was 26.18 years, 54.5% of female participation, 68.2% of leg localization, 59.1% patients with severe limitations of functional mobility, and preference for traditional medication 95.5%. After evaluation of efficiency, we concluded that there was no statistically significant difference between the two treatment protocols. Further studies with larger sample size are recommended.

关键词： Buruli Ulcer Functional Limitations Physiotherapy Kabat Technique

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Mucinous Carcinoma of the Scrotum about a Case in Yaounde

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Open Journal of Urology 2023年第6期13卷 173-177页

作者： Boris Amougou fred dikongue dikongue Divine Eyongeta Thierno Mamadou Oury Diallo David Douglas Banga Nkomo Demba Cisse Arlette Dongmo Alice Ghislaine Ndoumba Afouba Joseph Fondop Theodore Sala Beyeme Faustin Atemkeng Yaya Sow Abdoulaye Bobo Diallo Fru Angwafor Department of Surgery and Surgical Specialties Faculty of Medicine and Pharmaceutical Sciences University of Dschang Dschang Cameroon Department of Surgery and Surgical Specialties Faculty of Health Sciences of Buéa University Buéa Cameroon Faculty of Medicine and Pharmacy Gamal Abdel Nasser University Conakry Guinea Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Department of Surgery and Surgical Specialties Faculty of Health Sciences of Gaston Berger University Saint-Louis Senegal Department of Surgery Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon

Aim: This paper aims to report the second case of mucinous carcinoma of the scrotum revealed by scrotal fistulas listed in the literature and highlight the difficulties in the search and difficulties encountered in the management of urogenital cancers in developing countries. Case presentation: This was a 62-year-old patient who had consulted for fistulized lesions of the scrotum associated with urinary disorders. Physical examination found budding lesions in the scrotum from which mucus was leaking. The diagnostic assessment carried out consisted of a biopsy sample of the scrotal lesions, a blood analysis and medical imaging, which led to the diagnosis. The mutilating nature of the surgery proposed to the patient after multidisciplinary consultation meeting and the expensive cost of chemotherapy drugs constituted the limits of the patient’s therapeutic management. Conclusion: Mucinous carcinoma of the scrotum is rare and primary lesion should always be sought. The presence of budding lesions of the scrotum with discharge of mucus should suggest the diagnosis.

关键词： Scrotal Cancer Mucinous Carcinoma Scrotal Fistulas

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Combined peakreductionandself-consumptionusingproximalpolicy optimisation

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Energy and AI 2024年第2期16卷 24-31页

作者： Thijs Peirelinck Chris Hermans fred Spiessens Geert Deconinck ESAT KU LeuvenKasteelpark Arenberg 10 bus 24453001 LeuvenBelgium AMO Flemish Institute for Technological Research(VITO)Boeretang 2002400 Mol Belgium AMO EnergyVilleThor Park 83103600 GenkBelgium

Residential demand response programs aim to activate demand flexibility at the household *** recent years,reinforcement learning(RL)has gained significant attention for these type of applications.A major challenge of RL algorithms is data *** RL algorithms,such as proximal policy optimisation(PPO),have tried to increase data *** tionally,combining RL with transfer learning has been proposed in an effort to mitigate this *** this work,we further improve upon state-of-the-art transfer learning performance by incorporating demand response domain knowledge into the learning *** evaluate our approach on a demand response use case where peak shaving and self-consumption is incentivised by means of a capacity *** show our adapted version of PPO,combined with transfer learming,reduces cost by 14.51%compared to a regular hysteresis controller and by 6.68%compared to traditional PPO.

关键词： Demand response Reinforcement learning Electric water heater Peak shaving Transfer learning

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Modeling displacement flow inside a full-length casing string for well cementing

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Petroleum Research 2024年第1期9卷 1-16页

作者： Hu Dai Ali Eslami Jason Schneider Gefei Liu fred Schwering Pegasus Vertex Inc.USA Laval University Canada Sanjel Energy Services Canada Athabasca Oil Corporation Canada

While computer modeling of annular displacement efficiency is widely applied in cementing engineering,modeling the displacement flow inside a casing or drill string for cementing operations has received less *** predicting displacement efficiency inside a full-length pipe is desired by cementing engineers,the attempt of developing a model with both efficiency and accuracy faces *** to computer simulators for this purpose is *** with annular flow,the displacement flow inside pipe,although within a simpler geometry and without eccentricity effect,is not simpler in physics,modelling strategy and predictability,because a variety of flow patterns and flow instabilities can develop to create complicated fluid *** this paper,we present an integrated numerical model developed to simulate displacement flows inside a full-length pipe,which connects an existing annulus model to enable complete displacement simulations of cementing *** model uses three-dimensional grid to solve fluid concentrations with degrees of mixing,and incorporates flow instability detection and flow regime *** in cementing,the model accounts for effects of pumping rate,well inclination,pipe rotation,fluid densities,rheological parameters and *** computationally efficient model does not rely on high-resolution mesh as often required by conventional Computational Fluid Dynamics models,thus it is suitable to be implemented in a cementing software for daily use by well cementing *** methodology of the model is discussed in detail in this *** validate the model,we examine simulation results against experimental results obtained in our laboratory tests and CFD simulations;acceptable agreement is found under different testing *** also presented two case studies of real cementing jobs with cement evaluation logs compared to simulation results,showing that the model can predict consistent displacement efficie

关键词： Inside pipe displacement Displacement efficiency Numerical model Primary cementing Displacement flow

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