RESUMEN
Parts of the nosocomial infections issue are the professionally-acquired infections of health care workers. This problem is widely neglected in sub-Saharan Africa, and little is known on the subject, in spite of the high prevalence of blood-borne infections such as HIV or hepatitis B and C, and air-borne diseases like tuberculosis. Besides, unsafe practices and accidents like blood exposures are more frequent than in western countries. This is due to the lack of political concern, of safer equipment and of specific teachings. Most of this severe infections' treatments are long, difficult or unavailable in Subsaharan Africa. The loss of contaminated health care workers can then become devastating for their family and the fragile health care structures of those developing countries. Finally, one should not underestimate the risk of infection transmission from health care provider to patient, like in several past outbreaks of Ebola hemorrhagic fever.
Asunto(s)
Infección Hospitalaria/epidemiología , Personal de Salud , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/estadística & datos numéricos , Enfermedades Profesionales/epidemiología , África/epidemiología , Humanos , Factores de Riesgo , Medicina TropicalRESUMEN
PURPOSE: Aortoduodenal fistulas are the most frequent aortoenteric fistulas. They may be primary (occurring after aneurysms of the native aorta) or secondary (occurring after aortic prosthesis). Aortoduodenal fistulas are a rare complication of aortic prostheses. They may be caused by prosthesis infection or due to inadequate prosthesis. METHODS: We report seven observations that emphasize issues pertaining to either diagnosis or therapy. RESULTS: The delay of occurrence is variable, with a mean of 3 years as reported in the literature. Clinical picture includes upper digestive tract hemorrhage, sometimes fever, abdominal pain or mass. Though difficult, diagnosis can be achieved through gastric endoscopy or CT-scan. Additional diagnostic procedures are often not useful and should not be numerous. Surgical procedures help guide the diagnosis and constitute the main part of the treatment with suture of the duodenum and vascular prosthesis. According to previous works, our observations including prolonged follow-up of the patients suggest that the best vascular treatment is extra-anatomic axillo-bifemoral bypass, while simple suture and prosthesis replacement lead to poor results. CONCLUSION: Mortality related to aortodigestive fistulas is high (five out of seven patients in the present study) and requires prevention, including more particularly delicate surgery and antibiotic therapy in case of any episode of infection. Aortoduodenal fistulas must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained fever.