Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federati...

Context: Adjuvant radiotherapy (RT) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) is debated as benefits are inconstant. Molecular signatures for DCIS have been developed to stratify the risk of local recurrence (LR) and therefore guide the decision of RT. Objective: To evaluate, in women with DCIS treated by BCS, the impact of adjuvant RT on LR according to the molecular signature risk stratification. Methodology: We conducted a systematic review and meta-analysis of five articles including women with DCIS treated by BCS and with a molecular assay performed to stratify the risk, comparing the effect of BCS and RT versus BCS alone on LR including ipsilateral invasive (InvBE) and total breast events (TotBE). Results: The meta-analysis included 3478 women and evaluated two molecular signatures: Oncotype Dx DCIS (prognostic of LR), and DCISionRT (prognostic of LR and predictive of RT benefit). For DCISionRT, in the high-risk group, the pooled hazard ratio of BCS + RT versus BCS was 0.39 (95%CI 0.20–0.77) for InvBE and 0.34 (95%CI 0.22–0.52) for TotBE. In the low-risk group, the pooled hazard ratio of BCS + RT versus BCS was significant for TotBE at 0.62 (95%CI 0.39–0.99); however, it was not significant for InvBE (HR = 0.58 (95%CI 0.25–1.32)), Discussion: Molecular signatures are able to discriminate high- and low-risk women, high-risk ones having a significant benefit of RT in the reduction of invasive and in situ local recurrences, while in low-risk ones RT did not have a benefit for preventing invasive breast recurrence. The risk prediction of molecular signatures is independent of other risk stratification tools developed in DCIS, and have a tendency toward RT de-escalation. Further studies are needed to assess the impact on mortality.

Purpose: To describe the aspects of the positive diagnosis of large goiters. Patients and Methods: We conducted a retrospective and prospective study including 115 patients from January, 2009 till December, 2014 (6 years) in Central Hospital of University of Point G in Bamako (Mali). The diagnosis of large goiters was based on the measurements of the anterior neck swelling. Thus large goiter was defined as any goiter including the height or width was greater than or equal to 10 cm (centimeters). Results: We operated 115 cases of large goiters on 760 goiters operated either 15.1%. The average age of patients was 44, 43 years ±14, 3 with extremes of 9 and 80 years. There was 101 women (87.8%) and 14 men (12.2%) with a sex ratio of 7.2 in favor of women. The signs of compression were dyspnea in 40% of cases (46/115), dysphonia in 13.0% (15/115), and dysphagia in 8.6% (10/115). The average height of goiter was 12.1 cm ± 3.5 cm with extremes of 10 and 29 cm and the average width was 14.4 cm ± 5.4 cm with extremes of 10 and 32 cm. Thyroid ultrasound found large goiters multinodular in 100%. Cervical radiography found the tracheal deviation in 48.2% (42/87), tracheal compression in 20.6% (18/87), plunging goiters in 11.5% (10/87). Cytology found a benign goiter in 97.4% of cases (112/115), malignant (thyroid cancer) in 2.6% of cases (3/115). Conclusion: Diagnosis of large goiters was based on the measurement of the swelling in our context. The signs of compression are the severity of this condition.

Introduction: Cervical cystic lymphangiomas are rare benign dysembryoplastic tumors of lymphatic origin. Its severity in the child is due on one hand to their fast evolution and the compression of the way aerodigestive and on the other hand, by the classical difficulty of their excision. The purpose of this work was to report a case of giant cervical cystic lymphangioma in a child to discuss the difficulties associated with its management in our context. Observation: This was a 3-year-old female child who was admitted to the ENT department of CHU "Luxembourg" for right lateral cervical swelling. The clinical examination had noted a large anterior-latero cervical swelling of soft, renitent, painless palpation, movable in relation to the superficial and deep plane, measuring about 20 cm × 17 cm, the skin was healthy. It wasn't particularity to the rest of the physical examination. The diagnosis of giant cervical cystic lymphangioma was discussed. Thorough excision of the swelling by right lateral cervicotomy was performed. Anatomopathological examination of the operative specimen confirmed the diagnosis. The postoperative course was simple and the evolution was favorable. Conclusion: Cervical cystic lymphangiomas are rare. Their management involves surgery, with short and long-term post-operative outcomes are often excellent.

In 7 years, we brought together 100 cases of volvulus of the colon sigmoid to the hospital Sominé Dolo of Mopti among which the handle volvule was found without necrosis in 66 cases and necrosis 34 cases. Seventy-six patients benefited from a sigmoidectomy followed by a colorectal anatomize at a time, twenty one patients of an intervention of Hartmann. A surgical distortion was realized at 3 patients. All the patients operated by these last two techniques had a restoring of the digestive continuity for an average deadline of 90 days. The post-operative complications consisted of 11 cases of parietal suppuration and a case of evisceration. The average duration of follow-up was of 210 days. The post-operative mortality was 14%. It was about a state of toxic shock with visceral multi-failure (n = 13), and of a pulmonary embolism (n = 1). The treatment of the volvulus requires a fast diagnostic and therapeutic coverage. The best treatment consists of a resection of the sigmoid as a matter of urgency followed by an immediate anastomosis if the following conditions are carried achieved: state general voucher, experimented surgeon and if the resuscitation meadow, per and post-operative can be assured.