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

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.

Predictive value of SinoSCORE on in-hospital mortality and postoperative complications after coronary artery bypass surgery

Objective To evaluate the performance of the Sino System for Coronary Operative Risk Evaluation (SinoSCORE) on in hospital mortality and postoperative complications in patients undergoing coronary artery bypass grafting (CABG) in a single heart center. Methods From January 2007 to December 2008,clinical information of 201 consecutive patients undergoing isolated CABG in our hospital was collected. The SinoSCORE was used to

Surgical mortality in patients with malignant obstructive jaundice: a multivariate discriminant analysis

OBJECTIVE: To estimate the operative mortality in patients with malignant obstructive jaundice. METHODS: Twelve risk factors were analyzed using multivariate discriminant analysis in 90 patients who had been operated on. RESULTS: Operative mortality was significantly related to the following factors: age, duration of jaundice, packed RBC volume, white blood cell count and concentration of blood urine nitrogen; it was not significantly related to diseases and types of operation. The following formula was obtained: packed RBC volume×0.09954-age×0. 04018-blood urine nitrogen×0. 23693-duration of jaundice× 2. 07388-WBC count×0. 21118+5. 26593. With this formula, an operative mortality of 77. 8% was predicted. CONCLUSION: With a positive value from the formula, the patient should be operated on; otherwise non-operative treatment is advocated.

The Association between Preoperative Plasma C-Reactive Protein (CRP) Level and Postoperative Adult Heart Surgery Outcome

Introduction: Careful history and physical examinations are the best ways for preoperative evaluation. Currently, we are recommended to rely on doing them rather than unnecessary and costly laboratory tests for confirmation or diagnosis of disease. The aim of study is the survey of CRP level association to decide further evaluation and expert consultation, newly diagnosed problems and possible effect on postoperative mortality and morbidity. Methods and Materials: In a descriptive retrospective study, hospital documentation of 620 patients older than 18 years undergone heart surgery in Tabriz Shahid Madani hospital was evaluated. Addition to plasma CRP level, patient’s demographic information, type of surgery, preoperative significant tests, delay time in surgery start time after anesthesiology visit, cause of requested specialty consultation and treatment recommendation, postoperative complications and mortality rate were recorded and analyzed. Patients were classified according to preoperative plasma CRP level to five groups as negative, +1, +2, +3 and not measured (i.e. they considered as normal (0 - 5 mg/l), mildly (5 - 40 mg/l), moderately (40 - 200 mg/L) or severely increased (>200 mg/l) groups). Results: Of 620 patients, 402 were male and 218 were female. There was not statistically significant correlation among demographic variables (gender, age, weight, and height), heart disease diagnosis and the type of surgery in five groups. In 79 individuals, they were done specialty consultations that most common of them were neurology consultation because of impaired renal laboratory tests. Only 2 cases were due to high CRP level. In any of cases, this preoperative consultation didn’t result from new disease cases. CRP plasma level hadn’t association with preoperative red blood cell sedimentation level. Prevalence of preoperative acute myocardium infarction was higher in patients with high CRP level. In group +1, delay time was lower than other groups. The most common causes were cardiac causes. There wasn’t statistically significant correlation between CRP level and different postoperative complications. There wasn’t significant association between ICU stay time and postoperative hospital stay time and plasma high CRP level. Conclusion: Probably, plasma CRP level increases before surgery in acute myocardial infarction and results in high mortality rate. It seems that routine measurement of CRP in candidates for heart operation is beneficial for mortality rate prediction, so its increasing level can’t help to diagnosis newly cases and it isn’t prudent to consult with specialist.

Risk Prediction of Aortic Dissection Operation Based on Boosting Trees

During the COVID-19 pandemic,the treatment of aortic dissection has faced additional challenges.The necessary medical resources are in serious shortage,and the preoperative waiting time has been significantly prolonged due to the requirement to test for COVID-19 infection.In this work,we focus on the risk prediction of aortic dissection surgery under the influence of the COVID-19 pandemic.A general scheme of medical data processing is proposed,which includes five modules,namely problem definition,data preprocessing,data mining,result analysis,and knowledge application.Based on effective data preprocessing,feature analysis and boosting trees,our proposed fusion decision model can obtain 100%accuracy for early postoperative mortality prediction,which outperforms machine learning methods based on a single model such as LightGBM,XGBoost,and CatBoost.The results reveal the critical factors related to the postoperative mortality of aortic dissection,which can provide a theoretical basis for the formulation of clinical operation plans and help to effectively avoid risks in advance.

A Modified Surgical Approach of Hepatopancreatoduodenectomy for Advanced Gallbladder Cancer:Report of Two Cases and Literature Review

Gallbladder cancer（GBC） is the most common cancer of the biliary tract, constituting 80%–95% of malignant biliary tract tumors. Surgical resection is currently regarded as the sole curative treatment for GBC. Hepatopancreatoduodenectomy（HPD） has been adopted to remove the advanced gallbladder tumor together with the infiltrated parts within the liver, lower biliary tract and the peripancreatic region of GBC patients. However, patients who underwent HPD were reported to have a distinctly higher postoperative morbidity（71.4%, ranging from 30.8% to 100%） and mortality（13.2%, ranging from 2.4% to 46.9%） than those given pancreatoduodenectomy（PD） alone. We present two patients with advanced GBC who underwent a modified surgical approach of HPD： PD with microwave ablation（MWA） of adjacent liver tissues and the technique of intraductal cooling of major bile ducts. No serious complications like bile leakage, pancreatic fistula, hemorrhage and organ dysfunction, etc. occurred in the two patients. They had a rapid recovery with postoperative hospital stay being 14 days. Application of this approach effectively eliminated tumor-infiltrated adjacent tissues, and maximally reduced the postoperative morbidity and mortality. This modified surgical method is secure and efficacious for the treatment of locally advanced GBC.

Is age just a number: pancreaticoduodenectomy in elderly patients?

Pancreatic cancer incidence is increasing worldwide.While the developed countries have seen a greater increase in the age-standardized incidence rate of pancreatic cancer（29%from 1990-2013）,developing countries are also not spared（10%increase during the same time period）.