La prise en charge de l'atrésie de l'œsophage est encore limitée par la précarité des plateaux techniques à Madagascar. Les cas décrits dans ce travail ont pour objectif de relater nos possibilités thérapeutiques et de décrire les progrès à réaliser pour optimiser le traitement de cette pathologie congénitale. Nous avons recueilli tous les dossiers ayant pour motif d’entrée au service de Réanimation Chirurgicale du CHU JRA, Antananarivo, une atrésie de l’œsophage. Nous en avons retenu les tous premiers cas qui ont survécu sur une période de 42 mois entre janvier 2011 et juin 2014. Parmi 17 admissions pour atrésie de l’œsophage, trois nouveau-nés à terme, admis successivement en Réanimation Chirurgicale, présentant un type III d'atrésie; premiers patients, à Madagascar, ayant survécu au décours de leur intervention. Une seule patiente avait présenté des malformations associées. Ces trois bébés ont été extubés précocement au bloc opératoire, sous oxygénothérapie jusqu'à une ventilation spontanée efficace. Des séances de kinésithérapie postopératoire permettaient d'améliorer l'état respiratoire des nouveau-nés. La mortalité globale de cette pathologie en 42 mois a été de 76,5%. Malgré ces premiers succès, des progrès restent à entreprendre dans le traitement de cette anomalie congénitale ; de son diagnostic jusqu'à la période postopératoire. L'amélioration du plateau technique, surtout ventilatoire et du support nutritionnel permettrait d'avoir des résultats plus probants, tout comme dans les pays où des progrès ont été réalisés sur le plan de la réanimation.

Background Variceal upper gastrointestinal bleeding is a dreadful complication of portal hypertension with a significant morbidity and mortality. Different prognostic scores can be used. However, in the local context of Madagascar, the completion of paraclinical investigations can be delayed by the limited financial means of patients. Hence, determining clinical mortality risk factors of variceal upper gastrointestinal bleeding could be interesting. The aim of the study was to evaluate the clinical mortality risk factors of variceal gastrointestinal bleeding (VUGIB). Method An observational, cohort retrospective study was conducted over an 8-year period (2010–2017), at the surgical intensive care unit of the J.R. Andrianavalona University Hospital, Antananarivo, in patients admitted for VUGIB confirmed by upper gastrointestinal endoscopy and whose clinical examination was performed at admission. The primary endpoint was intensive care unit (ICU) mortality. Univariate analysis and multivariate logistic regression analysis were performed to identify risk factors for ICU mortality, with OR defining odds ratio. A p value <0.05 was considered significant. Results 1920 patients were admitted for gastrointestinal bleeding of any digestive causes; the source of bleeding was variceal in 269 patients (14%). The predominantly male population (sex ratio = 2.5), aged 47.1 ± 13.7 years was mostly American Society of Anesthesiologists (ASA) 1 classification (58.4%). In 56.5% of patients, the gastrointestinal bleeding had not occurred before. The mortality rate was 16.0%. Three major clinical factors of mortality were identified: previous endoscopic band variceal ligation (OR = 12.57 [2.18–72.58], p = 0.005), tachycardia >120 bpm (OR = 2.91 [1.04–8.14], p = 0.041), and ascites (OR = 3.80 [1.85–7.81], p < 0.001). Conclusion Upper gastrointestinal bleeding may be life-threatening. The mortality scores are certainly useful; however, the identification of clinical factors is interesting in countries like Madagascar, pending the results of paraclinical investigations.

We reported the case of an elderly child who was admitted to the neurosurgery department of the CHU-HJRA for headaches and vomiting. It is a child with obstructive hydrocephalus of tumor origin to whom a shunt ventriculoperitoneal has been placed. He had secondary a hydrocephalus by obstruction of the ventricular catheter secondary to a membrane causing dysfunction of the shunt system discovered during endoscopic surgery

Introduction: Few hospital practice enhanced recovery after caesarian section. Our aims is to evaluate the application of enhanced recovery after caesarian section after implementation in our service. Materials and Methods : An observational audit prospective was conducted, from November 2018 to January 2019, in the complex mother-child Military Hospital, Antsiranana. Patients between 18 to 35 years, ASA 1 or 2 before surgery were included. General anesthesia procedures are excluded. Results: Thirty-one patients were identified. Each received antiotic prophylaxis and prevention of postoperative nausea/ vomiting and intratechal morphine. Fluid infusion was optimized in 18 patients. In post-interventional recovery room, multimodal analgesia were given orally after the intervention in 15 patients (48%), Sixteen (52%) cases drunk. Forty-four patients (45%) ate food four hour after intervention. Stop infusion performed in 13 cases (42%). The bladder catheter removed in 13 patients (42%). The median length of stay was 3.5 days. Conclusion : Early food, removal of the bladder catheter and the infusion stop have low compliance to the protocol. An audit and formation were needed.

INTRODUCTION & AIM: Malaria is a major health problem in our country. Our aim is to determine the poor prognosis factors of this pathology.MATERIALS AND METHOD: A retrospective descriptive, analytical study was conducted in the intensive care unit of University Hospital Center of Joseph Raseta Befelatanana, during 24 months (June 2015 to May 2017). The severity was defined according to the recommendations for clinical practice (2007). We compared surviving and non-surviving patients.RESULTS: Fifty-six (56) cases were studied. The average age was 30 ± 11 years with a sex ratio of 6. Six cases had pulmonary disease. Neurological failure was present in 29 cases. Forty-seven cases were treated with quinine and 07 cases received norepinephrine. The length of stay was 3.55 ± 2.06 days. Eighteen subjects (32%) died. In multivariate analysis, neurological failure (p = 0.0001), jaundice (p = 0.0016), renal insufficiency (p <0.0001) and use of catecholamine (p = 0.0139) were associated with poor prognosis.CONCLUSION: The mortality of malaria was high. Neurological failure, jaundice, renal insufficiency and use of catecholamine were poor prognostic factors.