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Biomedical subjects

N Sinzobahamvya

Publications and source records attributed to N Sinzobahamvya.

12 recordsLinked to original sources
PubMed1994

[Surgical repair of common truncus arteriosus with homograft. Short- and mid-term results].

Between July 1987 and July 1993, 25 consecutive children with truncus arteriosus underwent complete surgical correction with homografts. Nineteen were under 6 months of age and 4 had an associated interruption of the aortic arch. Ten pulmonary and fifteen aortic homografts were implanted. They were cryopreserved with the exception of two, fresh aortic homografts. The diameters of the homografts varied from 8 to 19 mms. Two children who had an interruption of the aortic arch, aged 24 and 31 days, died in the peroperative period. The postoperative course was uncomplicated in only 3 cases; 20 patients had complications, including 9 cardiogenic shocks and 8 pulmonary hypertensive crises. The medium-term results included one death 4 months after surgery in an infant with an interruption of the aortic arch, and 2 successful homograft replacements 3 and 12 months after the initial repair for mycotic infection in 1 case and valvular stenosis in the other. The mean follow-up of the other 20 patients was 23 months: 14 were in NYHA functional Class I, 4 are on the waiting list for replacement of their homograft for obstruction after an average period of 47 months. The authors strategy is to perform surgical correction of truncus arteriosus very early: immediately in the neonatal period in cases with uncontrollable cardiac failure, at 6 months at the latest. Small homografts make this aggressive attitude feasible, but with an operative mortality in the first 6 months of life of 10.5% (2/19).(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1992

Anterior mediastinal abscess complicating septic arthritis.

An 11-year-old boy with septic arthritis of both knees presented with an anterior mediastinal abscess extending suprasternally. This was drained through a suprasternal incision and the mediastinal cavity was intermittently irrigated with povidone iodine solution and packed with gauze. Staphylococcus aureus was the responsible organism. Antibiotic therapy comprised of cloxacillin and gentamycin. Recovery was uneventful. This is, most probably, the first report on an anterior mediastinal abscess complicating a distant septic arthritis. As for any infective mediastinitis, early diagnosis and aggressive treatment is mandatory for a patient's survival.

Abscess↗
PubMed1991

Emergency pulmonary resection for pneumonia. High morbidity and mortality.

Emergency pulmonary resection was performed because of complicated pneumonia in eight patients (5 pneumonectomies, 2 lobectomies, 1 bilobectomy) over a 2-year period. The patients' age range was 5 months to 43 years. The indications were rapid aggravation of respiratory insufficiency in children with staphylococcal pneumonia and enlarging pneumatoceles, and massive hemoptysis in patients with chronic destructive pneumonia. Two patients died after pneumonectomy, one from contralateral aspiration and one from cardiogenic shock. Postoperative complications occurred in four cases--bronchopleural fistula and pyopneumothorax in three and thoracic empyema with massive chest-wall infection in one. Only two patients had an uneventful postoperative course. Complications of pulmonary necrosis in pneumonia may dictate urgent pulmonary resection, often pneumonectomy. Surgery will be life-saving in most cases, but high morbidity is to be expected.

Adult↗
PubMed1990

Oesophagectomy for carcinoma of the oesophagus--early results.

Oesophagectomy for squamous cell carcinoma of the oesophagus was performed in 25 consecutive patients over a 3.5 years period, for an overall resection rate of 11 pc. It was an Ivor-Lewis in 19 and a left thoracotomy in six. The stage of the disease was II in two, III in six and IV in 17 cases. Seventeen patients had uneventful postoperative evolution. Complications occurred in eight patients: heart failure in three, anastomotic leak in three, massive chest wall infection in two and four of these patients died: a mortality rate of 16 pc. All the 21 patients who left the hospital were able to take normal diet. The mortality of oesophagectomy for cancer can be as high as 30 pc but decreases with better selection of patients and surgical experience. Cure is rarely achieved. Resective surgery, when successful, offers the best palliation for dysphagia. Resectability rate in all African series is very low. There is a need for a more aggressive surgery therapeutic attitude. Our series shows that it is possible in our environment to achieve an acceptable operative morbidity and mortality. With increasing experience, results can only improve.

Adult↗
PubMed1990

Misdiagnosis of aneurysms: a case report.

Three cases in which aneurysms were misdiagnosed to less serous lesions are described. Attention is drawn to the possibility of these errors whose consequences can be fatal. Some of the problems associated with the handling of an inadvertently opened aneurysm are discussed.

Adolescent↗
PubMed1989

Pleural exudate in a tropical hospital.

In one hundred consecutive patients with non-purulent pleural exudates without apparent cause, the final diagnosis was tuberculosis in 58, malignancy in 20, pyogenic infection in four, cardiomyopathy in two, pulmonary infarction in one. The aetiology remained unknown in 15. The technique of "semi-open" pleural biopsy was performed under local anaesthesia. It accurately detected 70% of cancer and 69% of tuberculosis cases with a 9% complication rate and no mortality. Tuberculosis was seen at all ages but mainly between 20 and 39 yrs, where it represented 75% of cases. In this age group, malignancy was relatively rare: 10% of cases. In our environment of limited facilities, early chemotherapy trial for tuberculosis is justified for unknown pleural exudates in patients below the age of 40 yrs.

Adolescent↗
PubMed1988

Empyema thoracis in childhood in the tropics.

The management of 25 children with empyema thoracis in Zimbabwe is discussed. The method adopted in 21 of these children using simple drainage and continuous irrigation with 0.1% solution of povidone iodine compared well with more aggressive methods. The method can be carried out easily in a rural environment. 2 of these 21 children died, one because of aspiration. The results among the survivors were good - excellent in 14 of the 21 children and fair in 2. There were no side effects attributable to the povidone iodine. The method failed in 3 patients who had to be dealt with surgically. Staphylococcus aureus was the commonest organism responsible for empyema.

Anti-Bacterial Agents↗
PubMed1987

Purulent pericarditis.

Eleven children under 16 years of age with purulent pericarditis were seen in one hospital in one year. The condition was always secondary to a septic focus elsewhere, usually staphylococcal pneumonia; its incidence after pneumonia was 0.64%, but this may be an underestimate. Clinical diagnosis can be difficult in patients with pneumonia as the heart is not always enlarged. Persistent or progressive liver enlargement was an important diagnostic feature. The presence of excess pericardial fluid was easily confirmed by echocardiography. Early diagnosis and drainage followed by continuous irrigation with 0.1% povidone iodine solution usually resulted in rapid recovery, but two patients died.

Adolescent↗
PubMedDate not supplied

Arterial aneurysms associated with human immunodeficiency virus (HIV) infection.

The authors report four arterial aneurysms seen in three patients infected by HIV. The aneurysms affected: 1) the left common carotid artery in a young man HIV carrier, 2) the right common carotid artery and the abdominal aorta in a woman with AIDS, 3) the right common carotid artery in a patient with AIDS-related complex. The aetiology was found to be infectious, respectively: 1) staphylococcus epidermidis (certain), 2) tuberculosis or another undetected infection (possible), 3) staphylococcus epidermidis or syphilis (highly probable). A viral arteritis mechanism is also postulated in the second case. If this association of aneurysms with HIV infection is not fortuitous, an increase of aneurysm incidence in HIV infected population is to be expected.

AIDS-Related Complex↗
PubMedDate not supplied

Results of subxiphoid pericardiostomy in pericardial effusion.

37 patients with pericardial effusions were managed by early subxiphoid pericardiostomy under local anaesthesia in most cases (31/37). The aetiology was pyogenic infection in 21, tuberculosis in 7, trauma in 3, cardiomyopathy in one. It was unclear in five patients. The effusion recurred in two patients (one with pyogenic, the other with traumatic pericarditis). An infant with pyogenic pericarditis developed pericardial constriction. The mortality, mainly due to associated infections or diseases, was related to aetiology: 0% for tuberculosis and trauma, 19% (4/21) for pyogenic infections, 80% (4/5) for unclear causes. Overall results were good in 28 patients. Subxiphoid pericardiostomy is a simple and safe procedure which allows a quick differential diagnosis and drainage of pericardial effusions.

Adolescent↗
PubMedDate not supplied

Ruptured abdominal aortic aneurysm in a 24-year-old African woman. Unusual presentation--unknown aetiology.

CASE REPORT: 24-year-old black female presenting with progressive paralysis of the left lower limb. The clinical examination and investigations describe an extensive retroperitoneal mass. An exploratory laparotomy reveals a ruptured saccular infrarenal aortic aneurysm, a narrowing of the distal aorta and a complete obstruction of the left common iliac artery. The aneurysm was resected, an aortoiliac bypass and femorofemoral crossover bypass were performed, with success. The clinical presentation of this ruptured abdominal aneurysm is unusual. Its etiology is discussed: the findings are suggestive of Takayasu's disease.

Adult↗