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Les procédures douloureuses en reanimation sont nombreuses. L’objectif de l’étude était d’évaluer la prise en charge de la douleur liée aux soins dans un service de réanimation. Il s’agissait d’une étude descriptive et prospective allant du 1er janvier au 30 avril 2019. Etait inclus tout patient de plus de 18 ans admis dans le service de réanimation de l’Hôpital Central de Yaoundé devant recevoir un soin douloureux et dont le consentement du patient ou celui de son proche était obtenu. Les variables évaluées étaient le soin réalisé, l’intensité de la douleur, la prise en charge de la douleur et l’efficacité. L’intensité de la douleur était évaluée avec l’échelle visuelle analogique (EVA) chez les patients conscients et avec le Critical-care Pain Observation Tool (CPOT) chez les patients inconscients. Les données étaient analysées à l’aide du logiciel SPSS 17.0. L’échantillon était de 102 patients. L’âge moyen était de 36,7 ± 15,6 ans. Le sex-ratio était de 0,64. Les soins les plus fréquents étaient le pansement (18,6%). Le traitement préventif était non-médicamenteux (88,8%) et médicamenteux (11,2%). Aucun traitement curatif n’a été administré aux patients. Les soins les plus douloureux chez les patients conscients étaient les pansements (12,7%). Chez les patients inconscients, les soins les plus douloureux étaient l’intubation (3,9%) et l’aspiration trachéale (2,9%). La prise en charge était inefficace (n=64, 62,7%). La prise en charge de la douleur liée aux soins n’était pas efficace et adéquate. La mise en place de protocoles de soins serait un axe d’amélioration. English Summary Painful procedures in intensive care are numerous. The aim of the study was to assess the management of pain associated with care in an intensive care unit (ICU). This was a descriptive and prospective study running from January to April 2019. All patients over 18 years admitted to the ICU of the Yaoundé Central Hospital who receive a painful care were included. The patient's consent or that of his family member was obtained. The variables evaluated were the care provided, the intensity of the pain, the management of the pain and the effectiveness. Pain intensity was assessed with the visual analogue scale (VAS) in conscious patients and with the Critical-care Pain Observation Tool (CPOT) in unconscious patients. Data were analyzed using SPSS 17.0 software. The sample was 102 patients. The mean age was 36.7 ± 15.6 years. The sex ratio was 0.64. The most frequent care was the dressing (18.6%). The preventive treatment was non-drug (88.8%) and drug (11.2%). No curative treatment has been given to the patients. The most painful treatments for conscious patients were dressings (12.7%). In unconscious patients, the most painful treatments were intubation (3.9%) and tracheal aspiration (2.9%). Management was not effective (n=64, 62.7%). The management of care related pain was not effective and adequate. The establishment of protocols would be an area for improvement. Keywords: care related pain, treatment, efficiency, intensive care unit.

Resume Introduction L’intoxication aigue est une urgence courante et un probleme de sante publique dans les pays en voie d’emergence. Le but de notre etude etait d’etudier le profil epidemio-clinique des intoxications aigues de l’enfant a Yaounde. Patients et methodes Il s’agissait d’une etude observationnelle et retrospective realisee a l’Hopital gyneco-obstetrique et pediatrique de Yaounde. Les dossiers de patients âges de moins de 19 ans admis dans le service d’urgence pour une intoxication aigue entre le 1er janvier 2013 et le 31 decembre 2017 ont ete analyses. Les variables etudiees etaient les donnees cliniques, therapeutiques, et l’evolution clinique. L’analyse des donnees s’est faite grâce au logiciel Epi info version 3.5.4. Resultats La population etait composee de 158 enfants avec un sex ratio de 1,1. . La tranche d’âge de 1–5 ans etait majoritaire (n = 114, 72,2 %). La consultation etait realisee dans les 24 heures (n = 148, 93,7 %) et un seul toxique etait en cause dans 155 cas (n = 140, 98,1 %). L’intoxication etait essentiellement par voie orale (n = 156, 98,7 %) et accidentelle (88,6 %). Les principaux toxiques retrouves etaient les hydrocarbures (petrole lampant, 43, 27,5 %), les produits caustiques (21, 21,5 %) et les organophosphores/carbamates (29, 18,3 %.). Les signes et symptomes cliniques les plus retrouves etaient respiratoires (260, 48,7 %), digestifs (67, 42,4 %), et neurologiques (51, 32,3 %). L’antidote le plus utilise etait l’atropine associee a la pralidoxine. L’admission en reanimation survenait dans 17 cas (10,8 %). Le taux de mortalite etait de 3,2 % (n = 5). Conclusion Les intoxications aigues restent une cause frequente de consultation aux urgences chez les enfants âges de moins de 5 ans. Il est primordial de sensibiliser les parents au stockage securise des substances potentiellement toxiques.

We present a challenging case of severe pre-eclampsia later complicated by eclampsia, severe renal failure, intestinal intussusception, septic shock, and stroke in a 26-year-old female primigravid patient in third trimester. We navigate through the diagnostic and therapeutic challenges faced in managing our patient to bring out lessons and proposals to prevent and manage similar cases in the future.

The COVID-19 pandemic has strained health care systems beyond capacity resulting in many people not having access to life-sustaining measures even in well-resourced countries. Palliative and end-of-life care are therefore essential to alleviate suffering and ensure a continuum of care for patients unlikely to survive. This is challenging in sub-Saharan Africa where lack of trained teams on basic palliative care and reduced access to opioids limit implementation of palliative and end-of-life care. At the same time, health care providers have to cope with local cultural conceptions of death and absence of advance care directives.

Snake envenomation is an underestimated pathology in sub-Saharan Africa associated with severe emergencies, and even death in case of late presentation. We herein present a case of severe envenomation managed at the surgical emergency department of the Yaoundé Central Hospital.We report a case of a 47-year-old female farmer with no relevant past history who sustained a snakebite by an Echis occellatus viper during an agricultural activity. Her initial management consisted in visiting a traditional healer who administered her some herbal remedies orally and applied a white balm on the affected limb. Due to progressive deterioration of her condition, she was rushed to our surgical department where she arrived 20 h after the snakebite incident. On admission she presented in a state of shock (suggestive of an anaphylactic shock), coagulopathy, renal impairment, and gangrene of the entire right upper limb. Emergency management consisted of fluid resuscitation, repeated boluses of adrenaline, a total of three vials of polyvalent anti-venom sera, promethazine, analgesics, corticosteroids, and administration of fresh frozen plasma. Within four hours of emergency department hospitalisation she developped signs of sepsis and persistent hypotension refractory to fluid resuscitation, suggestive of an associated septic shock. Management pursued with antiobiotherapy and administration of noradrenaline through an electric pump syringe to achieve a mean arterial blood pressure above 65 mmHg. The patient deceased at the 10th hour of hospitalisation in a state of circulatory collapse unresponsive to vasopressors, coagulopathy, renal failure, sepsis and gangrene of the right forearm.The authors highlight this unusual presentation but equally pinpoint how late presentation to the emergency department, harmful tradition practices, poverty and cultural beliefs can adversely affect the prognosis of snakebite in our setting.

Background Malnutrition is a clinical condition of multifactorial etiologies and it is associated with several adverse outcomes. In high-income countries, malnutrition has been described as a determinant of delayed wound healing, surgical site infections and mortality in the postoperative period. There is limited information available regarding the outcome of surgery in malnourished patients in sub-Saharan Africa. Methods A cross-sectional analytic study was carried out between March and August 2014 in the visceral surgery and the emergency departments of the Yaounde Central Hospital in Cameroon. All consecutive consenting preoperative and postoperative patients of abdominal surgical procedures were enrolled. Variables studied were: socio-demographic characteristics, medical and surgical past histories, nutritional survey, anthropometric parameters and serum albumin level in order to determine the nutritional risk index (or Buzby score). Results A total of 85 patients aged from 19 to 50 years with mean age of 34.4 ± 8 years were included. The most performed abdominal surgical procedure was appendectomy (30.6%). The prevalence of preoperative malnutrition according to the Buzby score was 39.1%. Mean postoperative weight lost was 2.9 ± 1.2 kg and mean decrease in postoperative serum albumin was 4.2 ± 0.2 g. A normal postoperative serum albumin was associated with a favorable outcome [OR (95% CI) = 55 (13.4–224.3), p

Background The diagnosis of acute pulmonary embolism (PE) is one of the most challenging in emergency settings where prompt and accurate decisions need to be taken for life-saving purposes. Here, the assessment of the clinical probability of PE is a paramount step in its diagnosis. Although clinical probability models (CPM) for PE are routinely used in emergency departments (EDs) of low-resource settings, few studies have cited their diagnostic performances in sub-Saharan Africa (SSA). We aimed to comparatively assess the accuracy of four CPM in the diagnosis of acute PE in sub-Saharan Africans. Methods We carried out a cross-sectional study to compare the sensitivity, specificity, positive and negative predictive values and accuracy of four CPM namely; the Wells, simplified Wells, revised Geneva and the simplified revised Geneva (SRG) Scores to computed tomography pulmonary angiography (CTPA) in all adults patients with suspected PE admitted to the EDs of the Gynaeco-obstetric and Paediatric Hospital of Yaoundé and the Yaoundé Central Hospital in Cameroon between January 1, 2017 and April 30, 2018. Results In total, we enrolled 30 patients with clinical suspicion of acute PE. PE was confirmed on CTPA in 16 (53.3%) cases. Their mean age was 53.7 ± 15.5 years and 36.7% were males. All four scores had a diagnostic performance superior to 50% in all criteria assessed. The simplified Wells score had the highest sensitivity (62.5%) followed by the Wells score (56.3%). The SRG score had the highest specificity (71.4%). The score with highest PPV was the SRG score (66.7%) and that with the highest NPV was the Wells score (56.3%). Overall the models with the highest accuracies were the Wells and SRG scores (60% for each). Conclusion All CPM had a suboptimal diagnostic performance, perhaps highlighting the need of a more optimal CPM for acute PE in SSA. However, the Wells and the SRG scores appeared to be most accurate than the other two scores in the ED. Hence, both or either of them may be used in first intention to predict PE and guide which ED patients should undergo further investigations in an emergency SSA setting.

IntroductionPulmonary embolism poses one of the most challenging diagnoses in medicine. Resolving these diagnostic difficulties is more crucial in emergency departments where fast and accurate decisions are needed for a life-saving purpose. Here, clinical pretest evaluation is an important step in the diagnostic algorithm of pulmonary embolism. Although clinical probability scores are widely used in emergency departments of sub-Saharan Africa, no study has cited their diagnostic performance in this resource-constrained environment. This study will seek to assess the performance of four routinely used clinical prediction models in Cameroonians presenting with suspicion of pulmonary embolism at the emergency department.Methods and analysisIt will be a cross-sectional study comparing the sensitivity, specificity, positive and negative predictive values and accuracy of the Wells, Simplified Wells, Revised Geneva and the Simplified Revised Geneva Scores to CT pulmonary angiography as gold standard in all consecutive consenting patients aged above 15 years admitted for clinical suspicion of pulmonary embolism to the emergency departments of seven major referral hospitals of Cameroon between 1 July 2019 and 31 December 2020. The area under the receiver operating curve, calibration plots, Hosmer and Lemeshow statistics, observed/expected event rates, net benefit and decision curve will be measured of each the clinical prediction test to ascertain the clinical score with the best diagnostic performance.Ethics and disseminationClearance has been obtained from the Institutional Review Board of the Faculty of medicine and biomedical sciences of the University of Yaounde I, Cameroon and the directorates of all participating hospitals to conduct this study. Also, informed consent will be sought from each patient or their legal next of kin and parents for minors, before enrolment into this study. The final study will be published in a peer-review journal and the findings presented to health authorities and healthcare providers.

Les complications per et postopératoires en anesthésie pédiatrique ne sont pas rares. Notre objectif était d’étudier les complications per et post-opératoires chez les enfants opérés dans notre contexte. Il s’agissait d’une étude descriptive, analytique et prospective sur une période de cinq mois, dans deux hôpitaux de la ville de Yaoundé. Etaient inclus des patients âgés de 0 à 15 ans opérés et dont le consentement éclairé des parents était reçu. Les variables utilisées étaient : l’âge, le sexe, l’indication opératoire, la classeASA, la technique d’anesthésie,les complications peropératoires et postopératoires et l’évolution. Il était colligé151 patients dont 70,9% de garçons avec un sex ratio de 2,4. La tranche d’âge la plus représentée était celle de 1 à 5 ans (39,7%) pour un âge moyen de 4,4 ± 4,5ans. La spécialité chirurgicale la plus représentée était la chirurgie digestive. La chirurgie était programmée dans 75% des cas et la classeASA1 représentait 61% des cas. L’anesthésie générale était utilisée dans 97% des cas. 33,1% de patients avaient développé au moins une complication. Les complications peropératoires étaient les plus fréquentes (77,8%, n=70) à prédominance respiratoire (40%, n=28). Les complications postopératoires les plus fréquentes étaient cardiovasculaires (40%, n=8) et infectieuses (20%, n=4). Le taux de mortalité était de 7,9%, (n=12). Lesfacteurs associés à la survenue de complications étaient l’âge de moins de 1 an et le caractère urgent de la chirurgie. Les complications périopératoires sont fréquentes avec une prédominance respiratoire. Le taux de mortalité en anesthésie pédiatrique reste élevé dans notre contexte.Mots-clés : anesthésie pédiatrique, complications, mortalité. To assess the intraoperative and postoperative complications in children in our context. Materials and methods: It was a prospective, descriptiveand analytic study carried out during a period of 5 months, in children aged from 0 to 15 years old, operatedin two hospitals in Yaoundé, which we had previously received the informed consent of parentsto participate. The variables used were: age, sex, indication for surgery, ASA class, anesthesia’s technique, intra and post-operative complications and outcome.We included 151 patients during the study period with 70.9% of boys with a sex ratio of 2.4 for males. The age group most represented age was that of 1 to 5 years (39.7%) with an average age of 4.4 years ± 4.5. The most represented surgical specialty was digestive surgery. The surgery was scheduled in 75 % of cases and the ASA class 1 was the most representedwith 61%. General anesthesia was used in 97% of cases. We had 33.1% of patients who developed at least one complicationand 46.1%. Intraoperative complicationsrepresented 77.8%. Respiratory complications were the most represented with 40%. Postoperative complications are cardiovascular and infectious. We recorded 12 deaths for a mortality rate of 7.9%. The factors associated with the occurrence of complications were age less than 1 year and the urgency of the surgery. The complications were frequent. The respiratory complications were most represented. The mortality rate remains high in our context. Keywords: Paediatric anesthesia, complications, mortality

L’amélioration de la qualité des soins administrés aux patients durant la période périopératoire est une priorité. Le but de notre étude était d’évaluer la satisfaction du vécu périopératoire des patients après une anesthésie générale. Il s’agissait d’une étude transversale, analytique, menée durant 6 mois à l’Hôpital Central et à l’Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé. Les participants étaient les patients opérés sous anesthésie générale après une chirurgie programmée. L’outil de collecte des données était un questionnaire administré. Les variables étudiées étaient : les données sociodémographiques, le profil clinique des patients, les dimensions de l’échelle EVAN-G (l’information donnée aux patients, les délais d’attente, le respect de l’intimité, le confort, l’attention et la prise en charge de la douleur). Les données étaient recueillies et analysées par le logiciel SPSS version 20.0. Cent deux patientsremplissaient les critères d’inclusion. Le sex-ratio était de 0,3 en faveur des femmes. La classeASA2 était la plusreprésentée (52%). Trente un pour cent des patients avaient déjà été opérés. La chirurgie la plus pratiquée était la chirurgie gynécologique (56,9%). Les patients étaientsatisfaits de l’information reçue dans 84,3% des cas et dans 86,2% des cas, ils étaient satisfaits de la prise en charge de la douleur. Dans 68,8% des cas, les patients étaient satisfaits des délais d’attente. Quatre vingt cing pour cent des patients étaient globalement satisfaits du confort. Concernant le respect de l’intimité, 86,3% des patients étaientsatisfaits. La satisfaction globale des patients était de 69,7 ± 9,4. La plus grande moyenne de satisfaction concernait le confort (73,5 ± 12,9). Les moyennes les plus basses étaient celle de l’information (65,5 ± 12,5) et des délais d’attente (64,5 ± 15,2). Les facteurs influençant la satisfaction étaient : l’âge (valeur P=0,008), les antécédents chirurgicaux (valeur P=0,001) et les suites opératoires simples (0,009).Mots clés : satisfaction, vécu périopératoire, anesthésie générale.An improve in the quality of care given to patients during the perioperative period is a priority. The aim of our study was to evaluate the satisfaction of the perioperative experience of patients undergoing general anesthesia. We carried out a cross-sectional analytical study during 6 months at the Yaoundé Central Hospital and the Gynaeco-obstetric and Pediatric Hospital of Yaoundé. Patients operated under general anesthesia for a elective surgery were enrolled. The data collection tool was an administered questionnaire of 26 questions based on the EVAN-G scale. Data were collected and analyzed using SPSS version 20.0. One hundred and two patients fulfilled our inclusion criteria. The sex-ratio was 0.3 for women. 52% of patients were classified as ASA 2. Gynecologicalsurgery wasthe most practiced (56.9%). 84.3% of patients were satisfied with the information received. In 86.2% of cases, the patients were satisfied with the management of pain. In 68.8% of cases, patients were satisfied with the waiting period. As concerns comfort, 85.3% of patients were globally satisfied. Concerning respect of intimacy, 86.3% were satisfied. In 85.3% of cases, the patients were satisfied with the level of attention accorded to them. Taking into account all the above elements, the global satisfaction of patients was at 69.7±9.4. The greatest mean of satisfaction concerned comfort (73.5±12.9). The least mean were those of information (65.5±12.5) and waiting duration (64.5±15.2). Factors influencing satisfaction were: age (p value =0.008), past surgical history (p value=0.001).Key words: satisfaction, perioperative experience, general anesthesia

Congenital heart block (CHB) is rare disorder that has a higher mortality when associated with structural congenital heart defects. Very few cases have been reported in Sub-Saharan Africa (SSA). We present a case of complete CHB associated with a complex congenital heart defect in a neonate in Cameroon. A 1-month-old neonate in Cameroon was referred for the evaluation of bradycardia. The obstetrical ultrasound done during pregnancy revealed fetal bradycardia without further evaluation. Clinical examination showed well a developed neonate with bradycardia at 62 beats/minute, and mild cyanosis with oxygen saturation at 93% at room air. There were no signs of heart failure. Twelve lead electrocardiogram (ECG) demonstrated a complete atrioventricular conduction block with a junctional escape rhythm at 59/minute, left axis deviation and bi-ventricular hypertrophy. Two-dimensional echocardiography revealed a complex congenital heart disease with the following abnormalities: dextrocardia, complete atrioventricular canal with a single atrium and mild atrioventricular valve regurgitation and malposition of the great vessels with a posterior aorta and an anterior pulmonary artery. This case report highlights the challenges in the diagnosis and management of complex CHBs in low resource settings. A properly performed pregnancy follow-up with serial echocardiograms could aid in antenatal diagnosis and plan perinatal management when appropriate in order to optimize outcome. This emphasizes the clinical value of high quality antenatal care and proper screening.

Background: Preeclampsia is a major cause of maternal mortality. Eclampsia is a dramatic complication of preeclampsia. This study aimed at identifying clinical predictors of eclampsia among preeclamptic patients. Methods: We carried out a case-control study from November 1, 2014 to April 30, 2015 in six health facilities in Yaounde. Cases were women who have had eclamptic seizures antepartum, perpartum or within 48 hours of delivery. Controls were preeclamptic women who did not convulse till 48 hours after delivery. Unadjusted and adjusted Odds Ratios were calculated. Results: After univariable analysis the following parameters were associated with eclampsia: headache (uOR: 2.9; 95% CI: 1.4-6.2) and absence of stable income (uOR: 17.6; 95% CI: 6.2-49.8). After multivariate analysis predictors of eclampsia among pre-eclamptic patients were: age

Introduction: Our objective was to compare the epidemiologic profile of maternal mortality in two structures serving as referral levels of care in Cameroon. Methodology: This cross-sectional, comparative study took place at the maternities of the Yaounde Central Hospital (YCH) and the Bamenda Regional Hospital (BRH) from December 1st 2014 to May 31st 2015, a 6 months’ period. The medical records of deceased women over 5 years, from January 2010 to December 2014, were collected. We calculated the MMR (Maternal mortality rate) and studied the causes and risk factors associated with maternal death. The Epi info software 3.5.4 was used to analyze data with a significance level of P < 0.05. Results: The maternal mortality ratio (MMR) was 964 and 247 per 100,000 live births for YCH and BRH, respectively. More deaths occurred within the aged group range 20 to 34 years, 76.8% at YCH and 64.7% at BRH. At YCH, 70.7% of these patients were referrals versus 32.4% at BRH. Complication from abortion was often implicated at BRH (P = 0.007; OR = 0.31; CI = 0.13 - 0.74). Others causes were hemorrhage (YCH = 43.4%; BRH = 35.5%), hypertensive diseases (YCH = 17.2%; BRH = 14.7%) and infections (YCH = 8.1%; BRH = 17.6%). At YCH time elapsed from admission to death was

Background: Kaolin consumption is common in our sub-Saharan Africa. The objective of this study was to assess the effects of kaolin consumption on the outcome of surgery in women. Methods: It was a cohort study comparing the occurrence of complications during labor among 263 consecutively recruited women who underwent gynecologic or obstetric surgery at the Yaounde Gyneco-Obstetric and Pediatric Hospital, Cameroon. Sixty of them (22.8%) declared kaolin consumption before surgery and 203 (77.2%) who denied having consumed kaolin before surgery. Results: Kaolin consumption was found to predispose to postsurgical infections (RR=3.03; IC=1.82-5.05). Conclusions: Kaolin geophagia should be identified before surgery to prevent related postsurgical infections. A systematic ban of kaolin consumption is also recommended.

Introduction: La césarienne est une intervention qui nécessite une bonne prise en charge de la douleur. La prise en charge de la douleur post-opératoire (DPO) par les blocs de paroi est de plus en plus pratiquée. Le but de l’étude était de contribuer à l’amélioration de l’analgésie postopératoire au cours des césariennes par le Transversus abdominis plane bloc (TAP) chirurgical.Méthodologie: Il s’agissait d’une étude prospective et randomisée simple de cinq mois. Etaient inclues les patientes en instance pour césarienne à la Maternité principale de l’Hôpital Central de Yaoundé. Elles étaient divisées en deux groupes : groupe avec TAP bloc et groupe contrôle. Les variables étudiées étaient les données sociodémographiques, les scores de douleur au repos et à la mobilisation, la consommation des antalgiques, la satisfaction des patientes et le coût de la technique.Résultats: Quarante- huit patientes étaient recrutées et réparties en deux groupes. L’âge moyen était de 30,5 ± 6,05 ans. Les patientes ASA 1 représentaient 52% des cas et les césariennes étaient urgentes dans 77% des cas. Au repos et à la mobilisation, les scores de douleur étaient significatifs en faveur du groupe TAP bloc pendant les 48 premières heures (P ˂ 0,05). La consommation des antalgiques était faible dans le groupe TAP bloc, 64,3% des patientes n’avaient consommé que du paracétamol en période post-opératoire par rapport au groupe témoin où 90% avaient reçu une triple analgésie. Les patientes étaient satisfaites de la technique (89,3%). Le coût était évalué à 2.200 FCFA.Conclusion: Le TAP bloc chirurgical est une technique de réalisation facile, peu coûteuse et efficace.Mots clés: TAP bloc chirurgical, Analgésie, CésarienneEnglish Title: Interest of the surgical transversus abdominis plane block (TAP) in the management of analgesia after caesarean section at Central Hospital of YaoundéEnglish AbstractBackground: Caesarian section is painful explaining multimodal management in these interventions. Abdominal wall nerve blocks are becoming common practice. The aim of the study was to contribute in the improvement of the management of post operatory pain through the use of the surgical TAP block.Method: We carried out a prospective and simple randomized study over 5 months. We included patients operated for caesarian section at the Maternity of the Yaoundé Central Hospital. Participants were divided into two groups: a TAP block group, and a control group. Variables studied included sociodemographic data, pain evaluation scores at rest and on mobilization, analgesic consumption, patient satisfaction and cost of the technique.Results: Forty eight patients were recruited and distributed in two groups. The mean age of 30.5 ± 6.05 years. 52% of patients were classified ASA1 and 77% of the caesarian sections were emergency interventions. At rest and on mobilization, pain evaluation scores significantly in favor of less pain in the TAP group during the first 48 hours (p˂ 0.05). We found a reduced consumption of analgesics in the TAP group with 64.3% of women requiring only paracetamol as post-operatory analgesic as compared to the control group where 90% of women required triple analgesia. Patients showed an overall satisfaction with the technique (89.3%). Cost of the technique was evaluated at 2200 FCFA.Conclusion: Surgical TAP block is a simple, cheap, and efficient technique.Keywords: Surgical TAP block, Analgesia, Caesarian section

Introduction: La transfusion sanguine est la thérapeutique la plus rapide et la plus efficace en cas d’anémie sévère périopératoire. Le but de notre étude était de décrire la pratique transfusionnelle périopératoire à la Maternité Principale de l’Hôpital Central de Yaoundé (HCY).Méthodologie: Il s’agissait d’une étude prospective et descriptive de six mois. Etaient inclues toutes les patientes opérées à la Maternité Principale de l’HCY et transfusées. Les données recueillies étaient : les données sociodémographiques, les données cliniques (les antécédents médicaux, l’indication opératoire, la classe ASA, la technique d’anesthésie réalisée, les pertes sanguines estimées au bloc opératoire, les produits sanguins labiles commandés et transfusés), les données biologiques (groupe sanguin rhésus, taux d’hémoglobine en pré et postopératoire). Les données étaient analysées à partir des logiciels Epi info version 3.5.4. et Microsoft Office Excel 2013.Résultats: Cinquante-deux patientes étaient colligées. L’âge moyen était de 29,98 ± 7,3 ans, la tranche d’âge de 21 à 30 ans était la plus représentée (57,7%). La classe ASA II était la plus fréquente (50%). L’anesthésie générale était la technique la plus utilisée (69,23%). Le taux d’hémoglobine moyen préopératoire était de 5,64 ± 2,42 g/dl. Cent deux produits sanguins labiles avaient été prescrits, soit une moyenne de 1,96 par patiente. Le produit sanguin labile le plus commandé et transfusé était le culot globulaire avec une fréquence de 98,03%. La transfusion était effectuée en période peropératoire dans 74,5% des cas. La laparotomie d’urgence pour grossesse extra-utérine était associée au plus faible taux d’hémoglobine préopératoire 4,34±1,07 g/dl. Les indications de transfusion en période périopératoire étaient dominées par les grossesses extra-utérines (55,77%) et les hémorragies du 3ème trimestre (30,77%). Le taux d’hémoglobine postopératoire moyen au 5ème jour était de 8,15 ± 1,07g/dl.Conclusion: La transfusion périopératoire à la Maternité Principale concernait pour la plupart les femmes jeunes sans antécédent médical. Elle était effectuée majoritairement au cours des laparotomies pour grossesse extra-utérine.Mots-clés: Transfusion sanguine, périopératoire, Maternité, taux d’hémoglobine, Suites opératoiresEnglish Title: Perioperative blood transfusion in the maternity of Yaoundé Central HospitalEnglish AbstractBackground: Blood transfusion is the fastest and most efficient therapy in the management of severe perioperative anaemia. The aim of our study was to describe the procedure concerning perioperative transfusion at the maternity ward of the Yaoundé Central Hospital.Materials and methods: We carried out a prospective and descriptive study during six months. Were included in the study, patients operated at the Maternity ward of Yaoundé Central Hospital and who were transfused. Data collected were transcripted on a sheet. Data collected were: socio-demographic data (age, profession); clinical data (past medical history, indication for surgical treatment, ASA classification, the technique of anaesthesia realized, the estimated blood loss at the theatre, the nature and amount of blood derivatives ordered and perfused, the postoperative evolution) and biological information (ABO and Rhesus blood groups, preoperative and postoperative haemoglobin levels). Statistical analysis was done using the Epi-info program, version 3.5.4 and Microsoft Office Excel 2013.Results: Fifty two cases fulfilled our inclusion criteria. The mean age was 29.98 ± 7.3 years. The patients from 21 to 30 years represented 57.7% of cases. The medical past history most represented was gastritis in 68.42% of all cases, followed by HIV/AIDS in 15.79% of cases. Majority of patient were ASA II (50%). General anaesthesia was the mostly used technique (69.23%). The mean of preoperative haemoglobin level was 5.64±2.42 g/dl. The blood derivative mostly ordered and transfused was red blood cells concentrate (98.03%). The mean of ordered blood cell derivatives per patient was 1.96 units. Transfusion was realised at the preoperative period in 74.5% of cases. Emergency laparotomy indicated for ectopic pregnancy was associated with the lowest value of haemoglobin level during preoperative period (4.34±1.07 g/dl). Surgical indications with the necessity of perioperative period blood transfusion were dominated by ectopic pregnancy in 29 cases (55.77%), followed by third trimester haemorrhage in 16 cases (30.77%) and symptomatic fibroma in 5 cases (9.62%). The mean of haemoglobin level on the 5th day after surgery was 8.15±1.07 g/dl.Conclusion: Perioperative transfusion at the maternity ward at the Yaoundé Central Hospital concerns young women with no medical past history. In most of the cases, it was done during laparotomies indicated for ectopic pregnancy.Keywords: Blood transfusion- perioperative period- Maternity- Haemoglobin level-postoperative outcome

Le but de cette étude était d’évaluer les différentes attitudes des praticiens face aux anticoagulants en période périopératoire. Il s’agissait d’une étude observationnelle prospective du 1er janvier au 31 décembre 2012. Les patients étaient recrutés au CHU de Charleroi en Belgique et à l’Hôpital Général de Yaoundé au Cameroun. Tous les patients sous anticoagulants devant subir une intervention chirurgicale sous anesthésie générale étaient inclus dans notre étude. Les complications étaient collectées. Au total, 112 patients étaient retenus avec un sex-ratio homme/femme de 1 : 1,24. L’âge moyen était de 68,3 ± 16,01 ans. Les patients ASA II représentaient 61,6%. L'anticoagulant le plus utilisé était l’acenocoumarol (99,2%). Le relais était fait dans 90,9% des cas par de l’héparine de bas poids moléculaire (HBPM). Les durées d’arrêt de l’acenocoumarol allaient de 3 à 10 jours. Les doses d’héparine en relais étaient curatives dans 56,4% des cas. Dix sept complications peropératoires étaient enregistrées, dont hypotensions (16 cas) et choc hémorragique (1). En période post-opératoire immédiate, 97% des patients avaient reçu l’HBPM.Les doses d’anticoagulant en période post-opératoire étaient curatives dans 42,3% des cas. Le délai de reprise d’acenocoumarol était dans 70% de 48 heures. En période post-opératoire quatre cas de thrombose et quatre cas de saignement postopératoire étaient enregistrés. Quatre décès étaient enregistrés. En somme, ces résultats soulignent la nécessité d’avoir des protocoles de relais d’anticoagulants en période péri-opératoire unanimes.Mot-clés: Anticoagulants, Relais, ComplicationsEnglish AbstractThe aim of our study was to evaluate the different practices of anticoagulant bridging in our environment during and after surgery. We decided to carry out a prospective observational study during one year at the Yaoundé General Hospital in Cameroon and at the University Training Hospital of Charleroi in Belgium. Patients treated with anticoagulants, undergoing surgery under general anesthesia and agreeing to participate to our study were recruited and all embolic and hemorrhagic events were documented. 112 patients were studied, with a sex-ratio of 1:1.24. The mean age was 68.3±16.01 years. ASA II patients constituted 61.6% of our sample. Acenocoumarol was the most used anticoagulant (68%). All patients receiving OAC before surgery (72% of cases) received a bridging therapy. (90.9%) patients were treated with low molecular weight Heparin (LMWH). In 56.4% of cases LMWHs were given in curative dose. The bridging period varied from three to ten days. 17 cases of bleeding were observed associated to hypotension (16) and one case of hypovolemic choc. At postoperative period four major bleeding and four cases of thrombosis were registered. We registered four deaths. To conclude, it is necessary to establish approved bridging protocols in the future.Keywords: Anticoagulants, Bridging, Complications

Additional file 1. Supplemental material.

Les auteurs rapportent quatre cas d’hydrocéphalie chronique de l’adulte caractérisée par la triade clinique typique d’Adams-Hakim, confirmée par le scanner cérébral sans injection et traitée par dérivation ventriculo-péritonéale après un test à la ponction lombaire soustractive concluant. L’évolution a été marquée par une amélioration de la symptomatologie clinique quelques jours après la chirurgie. Ces observations relèvent la méconnaissance de cette entité clinique par les praticiens dans notre environnement; ce qui est à l’origine d’une arrivée et d’un diagnostic tardifs dans les services de neurochirurgie.We report the case of fourth patients, who presents a typical Adams – Hakim syndrom (chronic hydrocephalus of the adult). CT Scan of the brain showed enlarged ventricles; a ventriculo peritoneal shunt was inserted. Clinical symptoms regressed in the next few days. We present these cases because of the poor knowledge on this clinical syndrom by physicians responsible of late consultation and diagnosis in neurosurgery units.

Background Reliable data on severe head injury mortality is rarely reported in Sub-Saharan African countries and in Cameroon in particular. It was for this reason that for the first time ever a prospective study was carried out during a one year period in the university hospitals and some selected regional and district hospitals in Cameroon. Materials and methods All the patients admitted for head injury in the emergency units of the selected hospitals were enrolled and followed up over a period of one month. Results A total of 2835 consecutive patients were included with a sex ratio M/F = 3.7/1. One hundred and seventy nine (179) patients lost to follow up were not included. The mortality rate was 77% in the severe head injury group, 16% in the moderate head injury group and 1% in the mild head injury group. In the group of severely injured patients, the mortality rates were very high in the academic hospitals (Laquintinie Hospital of Douala, General Hospital of Douala, Yaounde Central Hospital, and Yaounde University Hospital; 83%, 83%, 81%, and 73% respectively) and in the Regional Hospital of Garoua (84%). Conclusion Mortality rates associated with head injury remain very high in Cameroon, and this is likely true in many countries across Sub-Saharan Africa. The figures approach the mortality expected in the natural history of the disease. Strategic plans should be taken at the local and national levels as in the case of maternal mortality and HIV infections.

Resume Objectif. – Determiner l'incidence des manifestations aigues chirurgicales des parasitoses digestives a Yaounde (Cameroun) et evaluer les modalites et les resultats de leur prise en charge. Materiel et methodes. – Il s'agit d'une etude retrospective de janvier 1973 a decembre 2002 incluant les patients presentant un abdomen aigu parasitaire traites dans le service des urgences chirurgicales de l'hopital central de Yaounde. Resultats. – Parmi 3464 abdomens aigus operes, 135 patients (3,9 %) avaient une etiologie parasitaire. Il s'agissait pour 59 % d'entre eux (80 patients) d'enfants âges de mois de 15 ans. Nous avons collige 63 peritonites par rupture d'abces amibien du foie (47 %), 24 occlusions par un ascaridiose (18 %), 21 appendicites d'origine parasitaire (15 %), 15 typhlites amibiennes (11 %), quatre angiocholites et/ou pancreatites aigues par migration d'un ascaris adulte dans l'ampoule de Vater (3 %), quatre perforations ascaridiennes du grele (3 %) et quatre invaginations intestinales aigues (3 %). Quatre-vingt-dix-sept patients (79 %) ont ete operes avant 1990. La mortalite des peritonites par rupture d'abces amibien du foie etait de 41 %. Conclusions. – Les urgences chirurgicales abdominales d'origine parasitaire sont peu frequentes mais pas rare au Cameroun. L'incidence de ces urgences diminue depuis quelques decennies. Cependant, la rupture intraperitoneale d'abces amibien du foie reste l'etiologie la plus frequente et est toujours associee a un taux important de mortalite. Il reste encore difficile d'affirmer lors de l'exploration chirurgicale si le parasite objective est le responsable ou le temoin passif des lesions observees. Le diagnostic preoperatoire des etiologies parasitaires pourrait permettre d'ameliorer leur prise en charge en privilegiant les modalites therapeutiques non operatoires.

Le principal but de ce travail était d’évaluer la qualité de remplissage de la fiche d’anesthésie, afin d’identifier les items non remplis et de proposer des améliorations. Il s’agissait d’une étude rétrospective, descriptive et transversale menée en 4 mois à l’Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé (HGOPY). Les fiches d’anesthésie des patients âgés de plus de 13 ans opérés sous anesthésie générale ou locorégionale à l’HGOPY de mars à juin 2013 ont été analysées. Nous avons défini un référentiel de 90 items à évaluer pour chaque fiche d’anesthésie : soit 54pour la période préopératoire, 25 pour la période peropératoire et 11 pour la période post-opératoire. Chaque item était jugé présent ou absent, non nécessaire ou non applicable. Chaque item a été noté sur 1 point. Chaque phase périopératoire a été notée sur 100 points. Nous avons recensé 315 fiches d’anesthésie à évaluer. Les patients étaient de sexe féminin dans 85,4%. La moyenne d’âge était de 26,8ans. La césarienne était la principale intervention (50,4%). Le taux de bon remplissage global de la période préopératoire était de 78,2%. Ceux des périodes peropératoire etpostopératoire étaient respectivement de 81,7% et 97,1%. L’item le mieux rempli était l’identification dans 100% des cas. Le taux de bon remplissageglobal des fiches d’anesthésie était de 80,5%. La qualité du remplissage des fiches d’anesthésie à HGOPY est bonne. Certains items doivent êtreaméliorés pour répondre aux normes internationales.Mots-clés : Evaluation, remplissage, fiche d’anesthésie The aim of this study was to evaluate the quality of filling sheets of anesthesia, identify the items that are not well filled and add items or sections to improve our anesthesia’s sheet. It was a retrospective study realized during four month in the Yaounde Gynaeco-Obstetric and PediatricHospital (YGOPH). The anesthesia sheets included were those of patients above 13 years old operated under general or locoregional anesthesia from march to april 2013. We have listed 90 items : 54 on the reoperative period, 25 in the intraoperative period and 11 for the postoperative period. Each item was considered present or absent, unnecessary or not applicable. Each item received a note of 1 point and each perioperative period was noted over 100 points. We enrolled 315 sheets of anesthesia. The patients were female in 85.4% of cases. The mean age was 26.8 years and cesarian section was realized in 50.6% of cases. The rate of good filling in the preanesthetic period was 78.2%. Those of intraoperative and postoperative period were respectively 87.1% and 97.1%. The best item recorded was the identification of patients in 100% of cases. The overall rate of good filling of anesthetic sheets was 80.5%. The quality of filling of anesthesia’s sheets was good. But certains items must be improved according to international norms.Key words : Evaluation, filling, anesthetic sheet

Le curage ganglionnaire dans les cancers pelviens apporte des renseignements histo-pronostiques nécessaire sur la survie globale et la survie sans récidive. Nous nous sommes appesantis sur la place réelle qu’occupe ce curage à Dakar en soulignant ces limites. De Janvier 2003 à Décembre 2012 nous avons étudié rétrospectivement les comptes rendus histopathologiques de tous les cancers pelviens opérés et analysés dans les laboratoires publics d’anatomie et cytologie pathologiques de Dakar. Nous avons colligé 470 cas de cancers pelviens dont 184 avaient bénéficié d’un curage ganglionnaire (39,14%). Le nombre moyen de ganglions retrouvé était de 5 (1/17). Le curageilio-obturateur était le plus pratiqué dans 42,93% (n=79). Le curage ganglionnaire dans les cancers pelviens était plus réalisé au stade précoce du cancer (n=75). Le taux global d’envahissement ganglionnaire était de 19,02% (n=35). Une taille ganglionnaire de plus de 1cm était associée à un risque élevé d’envahissement. Le nombre moyen de ganglion envahi par curage était de 4 (1/8). Un traitement néo-adjuvant fut réalisé dans 15,53% (n=73 cas) et était associé à une diminution du risque d’envahissement ganglionnaire. Le stade tumoral pathologique avancé était associé à un risque élevé d’envahissement ganglionnaire, une bonne différenciation tumorale était par contre associée à une diminution du risque. Aucun type histologique n’était associé à un risque d’envahissement nul. Le siège du curage n’était pas précisé dans 35,86% (n=66). L’effraction capsulaireet la taille tumorale étaient omises dans plus de la moitié des comptes rendus.Mots clés : Curage ganglionnaire, cancer pelvien, envahissement ganglionnaire.The pelvic lymph node dissection in cancer provides histo-prognostic information necessary for overall survival and relapse-free survival. We have scrutinized the actual place of such operation in Dakar by highlighting the limits. From January 2003 to December 2012, we studied respectivelyhistopathological reporting of all pelvic cancers which have been operated and analyzed in public laboratories of anatomical pathology and cytologyin Dakar. We collected 470 cases of pelvic cancers where lymphadenectomy had been applied in 184 cases (39.14 %). The average number of nodes found was 5 (1/17). Ilio-obturator lymph node dissection was most practiced in 42.93 % (n = 79). Lymphadenectomy in pelvic cancers wasmore applied at the early stage of cancer (n=75). The overall nodal rate was 19.02% (n=35). Lymph node size exceeding 1 cm was associated with a high risk of spread. The average number of lymph nodes involved by dissection was 4 (1/8). Neo-adjuvant treatment was performed in 15.53% (n = 73 cases), and was associated with a decreased risk of lymph nodes. The stage of advanced pathological tumor was associated with a high risk of lymph node invasion, whereas real tumor differentiation was associated with a lower risk. No histological type was associated with zerolymph node involvement. The seat of the dissection was not specified in 35.86 % (n = 66). The capsular break and tumor size were omitted inmore than half of the reports.Key words : lymphadenectomy, pelvic cancer, lymph node involvement.

Les affections chirurgicales des nerfs périphériques sont des pathologies peu étudiées en milieu neurochirurgical à Yaoundé. L’objectif de cetravail était d’étudier l’épidémiologie et les facteurs pronostiques de ces pathologies. Il s’agissait d’une étude rétrospective incluant tous lespatients opérés à l’Hôpital Central de Yaoundé d’une pathologie du nerf périphériques de Novembre 1999 à Novembre 2007. Vingt neuf (29) patients étaient inclus. Les pathologies traumatiques (15 patients), les syndromes canalaires (11 patients) et les tumeurs (3 patients) ont été observés. Concernant les traumatismes, le type de lésion retrouvé en per opératoire était la fibrose autour du tronc nerveux dans 10 cas (58,38%), la section complète du tronc nerveux dans 4 cas (23,52%) et la section partielle du tronc nerveux chez 1 patient (5,89%). Dans 2 cas aucune lésion n’était retrouvée. Le traitement chirurgical consistait en une neurolyse (10 cas) et une anastomose (direct ou avec greffon interposé) (4 cas) et une transposition du nerf (1 cas). Les résultats de la neurolyse étaient bons. Le taux de bons résultats était plus faible dans le groupe d’anastomose. Le facteur pronostic le plus important était le délai opératoire supérieur à 15 mois. Les syndromes canalaires dont 10 cas de canal carpien et les tumeurs (neurinomes) étaient plus rares.Mots clés : Nerfs périphériques, affections chirurgicales, traumatismes, neurinome, neurofibrome, syndrome du canal carpien, africainSurgical pathologies of peripheral nerves are less studied in neurosurgical units in Yaoundé. The aim of this study was to present the epidemiologyand the prognostic factors of these pathologies after surgery. We carried out a retrospective study enrolling all patients operated at the Yaoundé Central hospital for peripheral nerve pathology within the period of November 1999 to November 2007. Twenty-nine (29) patients were included. Trauma (15%), entrapment syndrome (11%) and neoplasia(3%) cases were observed. Concerning trauma cases, 10 cases (58.38 %) of fibrosis around the nerve bundle, 4 cases (23.52%) of completed nerve trunk section, and 1 case (5.89%) of partial nerve trunk section were diagnosed in the per operatory period. No lesion was found in two cases. The surgical management consisted of neurolysis (10 cases) and anastomosis in 4 cases (directly or with an onlay graft) and nerve transposition in 1 case. We obtained good results with neurolysis while the results with anastomosis were poor. The most important prognosticfactor was the delay of surgery above 15 months. The entrapment syndromes particularly carpal tunnel syndrome and neoplasia (neurinomas) were rare and represented only 10 cases.Key words : peripheral nerves, surgical pathologies, trauma, neurinomas, neurofibroma, carpal tunnel syndrom

L’absence d’innervation de l’encéphale donne la possibilité de réaliser des interventions neurochirurgicales sous anesthésie locale (AL), ce qui apparaît attractif par son coût, son accessibilité et son exigence relative en personnel qualifié. L’objectif de cette étude était d’évaluer les indications, les avantages et les complications de cette technique dans le service de neurochirurgie de l’Hôpital Central de Yaoundé. Tous les patients opérés sous anesthésie locale en neurochirurgie entre le 1er décembre 1999 et le 31 décembre 2001 ont été rétrospectivement inclus. Quarante cinq patients consécutifs ont été inclus dont 38 de sexe masculin et 7 de sexe féminin (sex ratio 5,4). L’âge moyen était de 49 ans avec des extrêmes de 9 ans et 89 ans. Les indications étaient : les hématomes sous-duraux chroniques (HSDC) (28 patients), les fractures-embarrures (7 patients), les empyèmes (2 patients), une tumeur extradurale (un patient), une tumeur pariétale temporale gauche extradurale (un patient) et les pathologies extra-crâniennes notamment le kyste dermoïde frontal (un patient), le kyste dermoïde péri orbitaire (un patient), et le neurinome du scalp (un patient). Tous les patients opérés d’un HSDC l’étaient sous AL à l’exception des nourrissons et des patients présentant une pneumopathie nécessitant une intubation endotrachéale. Les indications de l’AL pour les hématomes extraduraux aigus et les empyèmes étaient plus rares. L’HSDA et les tumeurs intra-parenchymateuses ont été opérés sous anesthésie générale. Les complications imputables à l’utilisation de l’anesthésique local ou à la technique n’ont pas été notées. Le seul désagrément était lié à la douleur ressentie par le patient lorsde l’infiltration de l’anesthésique local. L’anesthésie locale est une technique sim-ple, efficace et sûre lorsque les patients sont bien sélectionnés. L’indication de choix est l’HSDC et les tumeursextra crâniennes localisées. Les conditions socio-économiques et les facteurs de co-morbidités ne sont pas des éléments décisifsdans le choix du type d’anesthésie.Mots clés: neurochirurgie, anesthésie locale, hématome sous-dural, empyème.

Intracranial suppurations (ICS) are collections of pus of infectious origin in the skull. The authors present their experience.All children operated for ICS at the Central Hospital of Yaoundé from January 2000 to December 2008 were retrospectively included.Thirty-five patients were recruited: 26 (74.29 %) males and 9 (25.71 %) females. These represent 82.9 % of all ICS operated in our institution. ICS represented 14.3 % of intracranial space-occupying lesions. The mean age was 8.34 years. They presented with headaches (80.77 %), altered consciousness (20 %), convulsions (76 %), vomiting (20 %), unilateral motor deficit (69.23 %), speech disorders (12 %), and fever (89.29 %). Bergman's triad (51.86 %) was frequent. The primary infection was: meningitis, eight cases (22.85 %); sinusitis, six cases (17.14 %); head trauma, five cases (14.28 %); otitis media, one case (2.85 %); suppurations of the face, three cases (8.56 %); cardiopathy, one case (2.85 %); and craniotomy, one case (2.85 %). In seven cases (20 %), the origin was unknown. The lesions were empyema in 23 cases (65.71 %), cerebral abscess in 8 cases (22.85 %) and pyoventriculitis in 2 cases (5.72 %). The surgical procedures were burr holes (88.89 % of empyemas) and trepano-puncture-aspiration (75 % of abscesses). The mortality (21.42 %) and morbidity (42.85 %) were recorded.ICS are frequent but preventable (early treatment of the primary infection) pathologies of childhood in developing countries. Burr hole drainage (empyemas) and puncture-aspiration (abscesses) are simple, safe, and effective techniques.

Background Chronic subdural hematoma (CSDH) is frequent neurosurgical pathology but many issues related to the surgical procedure are still discussed.Objective To present our experience in the treatment of Non Acute Subdural Hematoma (NASH). Methodology This retrospective study included patients operated for NASH at the Yaoundé Central Hospital from January 2000 to September 2008. Surgery consisted of one burr hole (92.4%), 2 burr holes (3.6%), trephine or craniotomy (4%). All patients underwent per operative irrigation, a 48 hour-postoperative drainage and supine position. The burr hole was performed at the thickest point of the hematoma which in most cases corresponded to the intersection between the superior temporal line and the coronal suture. Results One hundred and ninety five consecutive patients were included: 155 males and 40 females. The mean age was 55 years. The past medical history revealed head injury (81.5%), alcoholism (12.9%), epilepsy (4.1%) or anticoagulation therapy (1.5%). The collection was unilateral (72.8%), bilateral (26.7%) or interhemispheric (1 case). On CT scan, the lesion was hypodense (79.9%), isodense (17.4%) or mixed (2.7%). The mortality rate was 2.5% while the recurrence rate was 3.7% after a 6 to 9 months follow-up period. The main recurrence factor was the inappropriate location of the burr hole.Conclusion One burr hole drainage is an effective and safe method for the treatment of NASH. The location of the burr hole is an important factor of recurrence. There is a need for Landmarked burr holes.