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Early Postoperative Deaths in the Surgical Intensive Care Unit of chu-kara

Open Journal of Internal Medicine 2023年第1期13卷 32-50页

作者： Essohanam Tabana Mouzou Sarakawabalo Assenouwe Pikabalo Tchetike Eyram Yoan Makafui Amekoudi Tchaa Hodabalo Towoezim Department of Anesthesia and Intensive Care at chu-kara Kara Togo Anesthesia Resuscitation service at chu-Sylvanus Olympio in Lomé Lomé Togo Medical Resuscitation and Nephrology Department of chu-kara Kara Togo trauma service chu-kara Kara Togo

Aim: Review of early postoperative deaths in the surgical intensive care unit at chu-kara. Introduction: Surgery, one of the means of treatment of diseases, also presents risks for the patient, including early postoperative death linked to numerous risk factors. Methodology: This was a retrospective descriptive study conducted on the records of patients who died within 48 hours after surgery from November 1, 2019 to April 30, 2021. The study was conducted in the surgical intensive care unit and in the operating room. Results: Thirty-two early postoperative deaths or 2.22% out of 1442 operated with 30 deaths retained for the study. Male gender predominated (70%). The average age was 31.22 years. Farmers were more concerned (66.67%). The time to surgery was 1.6 days. ASA1 patients (40%) predominated followed by ASA IV (30%). 80% of patients were operated on as an emergency. Digestive pathologies 80% were more represented. General anaesthesia 86.66% was more practiced associating Propofol, Fentanyl, Ketamine and Atropine more frequently. The average duration of the procedures was 132.5 minutes. Intraoperative complications were associated with cardiac arrest and hemorrhage (33.34%). ASA class higher than 2, dirty surgery (46.67%), and delayed recovery (13.34%) were the incriminating risk factors. Death by hemodynamic shock and respiratory distress were the main causes 26.66%. Conclusion: Early postoperative mortality was high and involved all ages. Anesthesia and surgery, the low level of qualification of the intraoperative actors, the lesser intraoperative security;the association of anesthetic effects, the complexity of intraoperative lesions led to the increase of mortality. The combination of two or more factors was pejorative for the deaths.

关键词： Mortality Early Postoperative Surgical Resuscitation chu-kara Togo

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traumatic abdominal wall hernia:a rare and often missed diagnosis in blunt trauma

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World Journal of Emergency Medicine 2022年第6期13卷 492-494页

作者： Sohil Pothiawala Sunder Balasubramaniam Mujeeb Taib Savitha Bhagvan trauma service Auckland City HospitalAuckland 1023New Zealand

Dear editor,traumatic abdominal wall hernia(TAWH)is defined as disruption of the abdominal wall musculature and fascia with herniation of intra-abdominal contents,in the absence of surgery to that area of the abdominal wall.[1]It is rare,with an incidence of 0.17%-0.90%in patients with blunt abdominal trauma.[2,3]Deceleration forces caused by falls from height or seat belt injuries are the most common causes of TAWH.[4]Low-energy blunt injuries from bicycle or motorcycles handlebars or charging animals are less frequent *** to the rare incidence and complex presentation of this condition with other distracting injuries,this diagnosis is often not considered,resulting in missed or delayed *** present a case of a 46-year-old male who suffered major abdominal trauma,and was found to have TAWH as well as intra-abdominal organ injury.

关键词： injuries abdominal diagnosis

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Rupture of abdominal aortic aneurysm into sigmoid colon:A case report

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World Journal of Gastroenterology 2006年第46期12卷 7549-7550页

作者： Murat Aksoy Hakan Yanar Korhan Taviloglu Cemalettin Ertekin Kemal Ayalp Fatih Yanar Recep Guloglu Mehmet Kurtoglu Istanbul University Istanbul Faculty of Medicine Trauma and Emergency Surgery Service Capa-Istanbul Turkey

Primary aorto-colic fistula is rarely reported in the literature. Although infrequently encountered, it is an important complication since it is usually fatal unless detected. Primary aorto-colic fistula is a spontaneous rupture of abdominal aortic aneurysm into the lumen of the adjacent colon loop. Here we report a case of primary aorto-colic fistula in a 54-year old male. The fistulated sigmoid colon was repaired by end-to-end anastomosis. Despite inotropic support, the patient died of sepsis and multiorgan failure on the first postoperative day.

关键词： Aortocolic fistula Abdominal aort aneurysm Rupture Lower gastrointestinal bleeding Aneurysm

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Primary Malignant Musculosqueletal Tumors of Members in Adult in Togo

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Open Journal of Orthopedics 2016年第4期6卷 103-107页

作者： Atchi Walla Faré Gnandi-Pio Piriziwè Dossim Gamal Ayouba Tchaa Towoezim Tchin Darre Anani Abalo Michel Dossim service de Chirurgie Orthopédique et traumatologique CHU SylvanusOlympio Lomé Togo service de Chirurgie Orthopédique et traumatologique CHU Kara Kara Togo service de Chirurgie Générale du CHP de Kpalimé Kpalimé Togo Laboratoire d’Anatomie et Cytologie Pathologiques CHU SylvanusOlympio Lomé Togo

Purpose: Primary malignant musculosqueletal tumors in adult are rare affections group and its treatment is still a real challenge today. The aim of this work was to describe the epidemiologic and treatment aspects of these tumors in the national reference center of our country. Materiel and Methods: It was a retrospective review of primary malignant musculosqueletal tumors treated in orthopedics and trauma unit of Sylvanus Olympio teaching hospital of Lomé, Togo from January 2000 to December 2014. Results: During the study period, 28 cases were selected and reviewed. There were 17 men (60.71%) and 11 women (39.29%). The average age was 32.7 years. There were 20 cases (71%) of primary malignant bone tumors (PMBT) and 8 cases (29%) of primary malignant soft tissues tumors (PMSTT). There were 6 (30%) of osteosarcoma. The tumor was located in the bones of the forearm and wrist/hand in 2 (10%) patients for each anatomical site;for the lower limb, around knee in 7 (35%) patients. Eight patients had PMSTT (28, 57%). There were three cases of rhabdomyosarcoma, 2 cases of fibrosarcoma. Tumors were located around knee in 4 cases and around ankle/foot in 3 cases. In the two groups of tumor, tumor resection was performed in 5 patients (17.86%) and limb amputation indicated in 23 patients (82.14%), was performed in 15 (53.57%) and 8 patients (37.78%), rejected it and left hospital against medical advice. Conclusion: Malignant musculoskeletal tumors are relatively rare in Togo. Their treatment is based on radical surgery which is often not supervised by adjuvant therapies. Ignorance, poverty of the population and embryonic state of diagnostic and treatment infrastructures are the obstacles to their care. Education and awareness must be integrated to care and fight against this group of diseases.

关键词： Primary Bone Tumors Soft Tissue Tumors Osteosarcoma Rhabdomyosarcoma Togo

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Timely completion of multiple life-saving interventions for traumatic haemorrhagic shock: a retrospective cohort study

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Burns & trauma 2019年第1期7卷 204-212页

作者： Biswadev Mitra Jordan Bade-Boon Mark C.Fitzgerald Ben Beck Peter A.Cameron National trauma Research Institute The Alfred Hospital89 Commercial RoadMelbourneVIC 3004Australia Emergency&trauma Centre The Alfred HospitalMelbourneAustralia School of Public Health and Preventive Medicine Monash University MelbourneAustralia trauma service The Alfred HospitalMelbourneAustralia Faculty of Medicine Laval University Quebec City QuebecCanada

Background:Early control of haemorrhage and optimisation of physiology are guiding principles of resuscitation after *** outcomes have been previously associated with single,timely *** aim of this study was to assess the association between multiple timely life-saving interventions(LSIs)and outcomes of traumatic haemorrhagic shock ***:A retrospective cohort study was undertaken of injured patients with haemorrhagic shock who presented to Alfered Emergency&trauma Centre between July 01,2010 and July 31,*** studied included chest decompression,control of external haemorrhage,pelvic binder application,transfusion of red cells and coagulation products and surgical control of bleeding through angio-embolisation or operative *** primary exposure variable was timely initiation of≥50%of the indicated *** association between the primary exposure variable and outcome of death at hospital discharge was adjusted for potential confounders using multivariable logistic regression *** association between total pre-hospital times and pre-hospital care times(time from ambulance at scene to trauma centre),in-hospital mortality and timely initiation of≥50%of the indicated interventions were ***:Of the 168 patients,54(32.1%)patients had≥50%of indicated LSI completed within the specified time *** delivery of LSI was independently associated with improved survival to hospital discharge(adjusted odds ratio(OR)for in-hospital death 0.17;95%confidence interval(CI)0.03–0.83;p=0.028).This association was independent of patient age,pre-hospital care time,injury severity score,initial serum lactate levels and *** patients with pre-hospital time of≥2 h,2(3.6%)received timely ***-hospital care times of≥2 h were associated with delayed LSIs and with in-hospital death(unadjusted OR 4.3;95%CI 1.4–13.0).Conclusions:Timely completion of LSI when indicated was completed in a small

关键词： Wounds Bundle of care Haemorrhage shock Resuscitation Emergency department Blood products Timely life-saving interventions trauma Injuries

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Management of Subtalar Fractures-Dislocations at Ségou Hospital in Mali: A 7 Cases Series

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Surgical Science 2020年第4期11卷 51-60页

作者： Mahamadou Diallo Abdoul Kadri Moussa Layes Toure Louis Traoré Cheick Oumar Sanogo Terna Traore Seydina Alioune Beye Abdrahamane Toure Making Mounkoro Mahamadou Kane Tiéman Coulibaly Orthopedic-trauma service Nianankoro Fomba Hospital Ségou Mali Orthopedic-trauma service Gabriel Touré Hospital Bamako Mali Orthopedic-trauma service Sikasso Hospital Sikasso Mali Orthopedic-trauma service Kati Hospital Kati Mali Anesthesia-Resuscitation service Nianankoro Fomba Hospital Ségou Mali

Introduction: Subtalar or peritalian dislocation is rare;it represents 15% of peritalian injuries. The aim of this study was to describe the radioclinical and therapeutic characteristics and to assess the functional result. Patients and Methods: This study is about a continuous descriptive and prospective study over a period of 5 years. It has been conducted from March 2013 to February 2018 at the Ségou Hospital, a second referral hospital in Mali. The functional results were evaluated by the score of the American Orthopedic Foot and Ankle Society (AOFAS). Results: Seven cases of subtalar dislocation fractures were diagnosed in six male patients with an average age of 38 years (36 to 47 years old). In five cases the etiology of the trauma was a motorcycle accident and a fall from height. The lesion was bilateral in one case. The average time to care was 3 hours (1 to 9 hours). There was one case of open dislocation fracture with talus enucleation. The dislocation was medial in 6 cases and lateral in one case. It was pure in three cases. The treatment was orthopedic in 2 cases and surgical in 5 cases. The post-operative complications were complicated by an infection of the operative site in one case. The average length of hospital stay was 4 days. The functional result was excellent in 2 cases;good in 2 cases, fair in 2 cases and poor for 1 case. Conclusion: Subtalar dislocation is a rare and serious lesion of the posterior tarsus. The long-term prognosis depends on the earliness of treatment and the severity of the associated injuries.

关键词： Fracture Dislocation Subtalar Prognosis Treatment

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Pre-Hospital Management of Craniocerebral trauma in South Saharan Africa: Cotonou Experience

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Open Journal of Modern Neurosurgery 2019年第3期9卷 221-226页

作者： Abd El Kader Moumouni Essossinam Kpelao Holden Olatoundji Fadigba Agbeko Achille Doleagbenou Ibrahima Berete Dabou Abiba Tamou Tabe Emile Mensah Martin Chobli chu kara Kara Togo SAMU Benin Cotonou Benin chu Sylvanus Olympio Lomé Togo University of Parakou Borgou Benin Universite Gamal de Conakry Conakry Guinee HIA Parakou Parakou Benin SAMU Benin of Parakou Borgou Benin

The management of craniocerebral trauma begins at the site of the accident. This is one of the diseases for which pre-hospital care is well codified. The objective of this study is to report the experience of the Emergency Aid Medical service (EMAS) of BENIN in the pre-hospital management of craniocerebral trauma. 146 head injuries were cared for. 116 were male. The mean age was 32 years with extremes ranging from 2 to 77 years. Etiology in 68% of patients was a public road accident. And the request for the use of the EMAS was made by highway users for 41% of the injuries. About 5.5% were severe cranio-brain injuries, more than 75% of which had died in intensive care. In 77% of the EMAS interventions, there was an intensive care physician in the team. 34 wounded had been transported in a vacuum mattress. The rigid cervical collar was used in 8 major traumas. All the wounded were transported by ambulance. The duration of hospitalization varied from a few hours in the emergency department to 90 days in the hospital ward. 9 patients died. One of them, who died in an ambulance, was a woman. The prehospital medical care of head trauma in BENIN is still progressing.

关键词： Emergency Craniocerebral Africa South-Sahara Pre Hospital Management

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Burn injury differentially alters whole-blood and organ glutathione synthesis rates: An experimental model

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Burns & trauma 2013年第2期1卷 87-94页

作者： Zhe-Wei Fei Vernon R. Young Xiao-Ming Lu Andrew B. Rhodes Ronald G.Tompkins Alan J. Fischman Yong-Ming Yu Shriners Burns Hospital and Burn & trauma service Massachusetts General Hospital Harvard Medical School Boston MA 02114 Shriners Burns Hospital and Burn & trauma service Massachusetts General Hospital Harvard Medical School Boston MA 02114 Laboratory of Human Nutrition Massachusetts Institute of Technology Cambridge MA 02142 USA

Previous studies from our laboratories revealed a reduced rate of whole-blood (WB) glutathione (GSH) synthesis in severely burned patients. To determine whether WB GSH metabolism is an indicator of the status of GSH metabolism in one or more of the major organs, we used a burn rabbit model to determine GSH concentrations and rates of synthesis in WB, liver, lungs, kidney, and skeletal muscle. L-[1-13C]-cysteine was infused intravenously for 6 h in rabbits at 3 days post-burn and in sham burn controls. WB and organ 13C-enrichment of cysteine and GSH was determined by gas chromatography/mass spectrometry. Plasma cysteine metabolic flux was increased significantly (P < 0.01) following burn injury. WB, liver, and lung GSH concentrations (P = 0.054, P < 0.05, and P < 0.05, respectively) and fractional rates of GSH synthesis (P < 0.05, P< 0.01, and P< 0.05, respectively) were reduced at 3 days post-burn. Kidney was unaffected. There also appears to be an increased rate of GSH transport out of the liver after burn injury. Hence, there is a differential impact of burn injury on tissue and organ GSH status, with WB qualitatively reflecting the changes in lung and liver. It will be important to determine whether these changes are due to alterations in the intrinsic capacity for GSH synthesis and/or availability of amino acid precursors of GSH.

关键词： Burn injury glutathione glutathione concentration synthesis rate whole blood

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Targeting harmful effects of non-excitatory amino acids as an alternative therapeutic strategy to reduce ischemic damage

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Neural Regeneration Research 2025年第9期20卷 2454-2463页

作者： Victoria Jiménez Carretero IrisÁlvarez-Merz Jorge Hernández-Campano Sergei A.Kirov Jesús M.Hernández-Guijo Department of Pharmacology and Therapeutic School of MedicineUniv.Autónoma de MadridMadridSpain Ramón y Cajal Institute for Health Research(IRYCIS) Neurobiology-Research ServiceHospital Ramón y CajalMadridSpain Institute of Neurobiology Faculty of Mathematics and Natural SciencesHeinrich Heine University DüsseldorfDüsseldorfGermany Department of Neuroscience and Regenerative Medicine&Department of Neurosurgery Medical College of Georgia at Augusta UniversityAugustaGAUSA

The involvement of the excitatory amino acids glutamate and aspartate in ce rebral ischemia and excitotoxicity is ***,the role of non-excitatory amino acids in brain damage following a stroke or brain trauma remains largely *** release of amino acids by necrotic cells in the ischemic core may contribute to the expansion of the *** findings indicated that the reversible loss of field excitato ry postsynaptic potentials caused by transient hypoxia became irreversible when exposed to a mixture of just four non-excitatory amino acids(L-alanine,glycine,L-glutamine,and L-serine)at their plasma *** amino acids induce swelling in the somas of neurons and astrocytes during hypoxia,along with permanent dendritic damage mediated by N-methyl-D-aspartate *** N-methyl-D-aspartate receptors prevented neuronal damage in the presence of these amino acids during *** is likely that astroglial swelling caused by the accumulation of these amino acids via the alanine-serine-cysteine transporter 2 exchanger and system N transporters activates volume-regulated anion channels,leading to the release of excitotoxins and subsequent neuronal damage through N-methyl-D-aspartate receptor ***,previously unrecognized mechanisms involving non-excitatory amino acids may contribute to the progression and expansion of brain injury in neurological emergencies such as stroke and traumatic brain *** these pathways co uld highlight new therapeutic targets to mitigate brain injury.

关键词： cell swelling N-methyl-D-aspartate receptor non-excitatory amino acids stroke synaptic transmission

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Chinese expert consensus on echelons treatment of pelvic fractures in modern war

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Military Medical Research 2018年第4期5卷 279-292页

作者： Zhao-Wen Zong Si-Wu Chen Hao Qin Hua-Ping Liang Lei Yang Yu-Feng Zhao State Key Laboratory of trauma Burn and Combined Injury Department of War Wound Rescue Skills Training Base of Army Health Service Training Army Medical University First Department Research Institute of Surgery Daping Hospital Army Medical University Department of trauma Surgery Daping Hospital Army Medical University

The characteristics and treatment of pelvic fractures vary between general conditions and modern war. An expert consensus has been reached based on pelvic injury epidemiology and the concepts of battlefield treatment combined with the existing levels of military medical care in modern warfare. According to this consensus, first aid, emergency treatment and early treatment of pelvic fractures are introduced in three separate levels. In Level Ⅰ facilities, simple triage and rapid treatment following the principles of advanced trauma life support are recommended to evaluate combat casualties during the first-aid stage. Re-evaluation, further immobilization and fixation, and hemostasis are recommended at Level Ⅱ facilities. At Level Ⅲ facilities, the main components of damage control surgery are recommended, including comprehensive hemostasis, a proper resuscitation strategy, the treatment of concurrent visceral and blood vessel damage, and battlefield intensive care. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.

关键词： Pelvic fractures Combat injuries Classification and treatment Expert consensus

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