The case series of functional adrenal tumors: Experience of two tertiary hospitals in Yaoundé, Cameroon.

INTRODUCTION: Adrenal tumors are often found incidentally during abdominal imaging. Functioning adrenal tumors are less frequent than these incidentalomas discovered unexpectedly. We report treatment outcomes (major complications) of 7 cases of symptomatic adrenal masses from 2009 to 2019. PRESENTATION OF THE CASES: Seven cases of functioning adrenal tumors: four adenomas presenting with Cushing's syndrome, two adrenal carcinomas, and one pheochromocytoma are described. The preoperative diagnoses were made through clinical manifestations, an increase in urinary free cortisol with normal ACTH, elevated metanephrine and enlarged masses on CT. The diagnoses were established on histopathology of adrenalectomy specimens. Adrenal insufficiency in two patients following surgery was corrected with corticoid replacement therapy. One patient died of hypovolemia the day of surgery and another from anaphylactic shock (allergy) late in the post-operative period. DISCUSSION: Pre, intra and post-operative complications from vascular instability often complicate surgery in functioning adrenal tumors. Adrenal adenomas manifest as Cushing's syndrome in 10-15 % of patients. They are the most common adrenal tumor although the diagnosis is most often coincidental to abdominal imaging. The incidence of adrenal adenoma increases with age, up to 7 % in the seventh decade. Laparoscopic adrenalectomy, which was not available in our hospitals then, is standard treatment for most tumors. It is alleged to have better outcomes in trained and tested hands. CONCLUSION: Surgery of functioning adrenal tumors demands close collaboration of multiple clinical disciplines to manage vascular instability and adrenal insufficiency, especially in resource strapped communities.

Acute Urinary Retention in the Male Child from Urethral Calculi: A Report of Three Cases.

Urinary stones are uncommon in children. Urethral location of calculi can give rise to various clinical manifestations. We report three cases of urethral lithiasis presenting with acute urinary retention in children.

Challenges in the Diagnosis and Management of Acquired Nontraumatic Urethral Strictures in Boys in Yaoundé, Cameroon.

Introduction. Urethral strictures in boys denote narrowing of the urethra which can be congenital or acquired. In case of acquired strictures, the etiology is iatrogenic or traumatic and rarely infectious or inflammatory. The aim of this study was to highlight the diagnostic and therapeutic difficulties of acquired nontraumatic urethral strictures in boys in Yaoundé, Cameroon. Methodology. The authors report five cases of nontraumatic urethral strictures managed at the Pediatric Surgery Department of the YGOPH over a two-year period (November 2012-November 2014). In order to confirm the diagnosis of urethral stricture, all patients were assessed with both cystourethrography and urethrocystoscopy. Results. In all the cases the urethra was inflammatory with either a single or multiple strictures. The surgical management included internal urethrotomy (n = 1), urethral dilatation (n = 1), vesicostomy (n = 2), and urethral catheterization (n = 3). With a median follow-up of 8.2 months (4-16 months) all patients remained symptoms-free. Conclusion. The authors report the difficulties encountered in the diagnosis and management of nontraumatic urethral strictures in boys at a tertiary hospital in Yaoundé, Cameroon. The existence of an inflammatory etiology of urethral strictures in boys deserves to be considered.

Community acceptability of the use of low-dose niclosamide (Bayluscide), as a molluscicide in the control of human schistosomiasis in Sahelian Cameroon.

Although field trials of the application of molluscicides for the control of human schistosomiasis have been conducted in several settings, the acceptability of molluscide use at the community level has been poorly documented. The death and putrefaction of aquatic organisms in water treated with niclosamide (Bayluscide), for example, and the yellowish colouration of such water, may decrease the molluscide's acceptability. It may be possible, however, to use doses of a molluscicide that are only just high enough to kill the target snails but not high enough to kill non-target fish and frogs, thereby reducing the application's impact on water quality and colour and improving its acceptability to local communities. In a study in northern Cameroon, Bayluscide WP70 was applied to ponds at concentrations of 0, 0.25, 0.5 or 1 g/m(3). Changes in human contact with the water in the ponds were explored both by direct observation and by in-depth interviews with key informants from the local community. Although all applications of niclosamide greatly decreased human use of the treated ponds for a few days, most informants (99%) were in favour of niclosamide application and only 6% of the interviewees gave change in water colour or bad smell as a reason for not using a particular water body. Over the few days post-application, use of ponds treated with 0.25 or 0.5 g Bayluscide WP70/m(3) was higher than that of the ponds treated with 1 g/m(3), indicating that relatively low-dose applications, if effective in controlling snails, may be more acceptable to local communities than applications at higher doses.

Field trials of low dose Bayluscide on snail hosts of schistosome and selected non-target organisms in sahelian Cameroon.

More than 85% of all cases of schistosomiasis in Cameroon occur in the northern sahelian half of the country representing 20% of the population. Several workers have advocated the integrated approach to schistosomiasis control, including snail control, but the death and decay of aquatic organisms, and fish kill that often follows Bayluscide application at the dose of 1 g/m3 decrease its acceptability. The present study was designed to assess the effect of lower Bayluscide doses on snail host and non-target fish, frog, the tadpole kill. Bayluscide was applied to study ponds at concentrations of 0, 0.25, 0.5, and 1 g/m3 (ppm). Pre and post application assessment of snails hosts of schistosomes, fish, frog, and tadpole kill were carried out. All 0.25, 0.5, and 1 g/m3 Bayluscide concentrations reduced snail population significantly. Bayluscide concentration of 0.50 g/m3 applied in two rounds of 0.25 g/m3 resulted in high snail mortality and low lethality to fish, frogs, and tadpoles. Further studies are needed to assess the cost-effectiveness of Bayluscide in the control of schistosomiasis following the simplified approach.

Candiduria in HIV Infected Patients in Yaounde; Cameroon

Objective: To detect Candida species in the urine of patients living with human immuno-deficiency virus (HIV); and correlate the presence of candiduria and CD4 counts. Patients and Methods: The study population consisted of 105 hospitalized patients from the Military and Central Hospitals of Yaounde; who either were HIV positive or already suffering from AIDS. The patients consisted of 63 females (60) and 42 males (40) giving a male to female ratio of 1:1.5. Midstream urine samples were collected from all patients and mycological examination of the centrifuged sediments was done. Patients with CD4 counts 499 lymphocytes/mm3 were a proxy control group. Results: 38 of 105 (36.2) subjects had candiduria. 71of the cases were asympto-matic. The percentage of patients positive versus negative for candiduria increased progressively from stage-A (5) to B (32) to C (63) HIV infection. There was thus a correlation between candiduria and the CDC disease stage. Its presence heralded an advanced immuno-suppressed state of the AIDS patient. Conclusion: In resource-poor communities; where viral copy and CD4 count determination are expensive; candiduria may serve as one of the indicators for anti-retroviral therapy. We recommend routine detection of candiduria in this high-risk group of HIV/AIDS patients

High-grade intra-epithelial neoplasia and prostate cancer in Dibombari, Cameroon.

High-grade prostatic intra-epithelial neoplasia (HGPIN) occurs a decade earlier in men of African descent in the US and Brazil, compared to white men. Prostate cancer incidence and mortality is worse in the African-American than in US white men. Sub-Saharan Africa was thought to be a low incidence area. This disparity has been attributed to lifestyle factors such as diet. We report the results of prostatic biopsies, from an ongoing national prostate cancer survey. One hundred and eleven men aged 40 y and over were recruited for medical interview (AUA symptom score), prostate specific antigen (PSA) assay and digital rectal examination (DRE). Between six and 10 cores of random digitally guided needle biopsies were performed on 24 subjects that had either suspicious prostates on digital rectal examination +/ or PSA > or =4 ng/ml. All lesions of the prostate were described on routine histopathology. The Gleason score and proportion of tissue involved with cancer, was determined. Eight men had benign prostatic hyperplasia (BPH), six had cancer, another six had low grade intra-epithelial neoplasia, two had HGPIN, there was one case of BPH and chronic prostatitis and one case of chronic prostatitis only. The cancer patients were aged 58-75 y (mean 66.93 y). Gleason scores ranged from 5 to 9, there was one score of 3. Cancer made up 20-80% tissue samples. HGPIN was found in two cases (mean age 58 y). Significant prostate cancer and the pre-cancerous lesion HGPIN exist in Dibombari, Cameroon. The purported low incidence of prostate cancer may reflect cultural and economic barriers to health care.

Expression of soluble urokinase plasminogen activator receptor may be related to outcome in prostate cancer patients.

The urokinase-type plasminogen activator receptor (uPAR) exists as a GPI anchored glycoprotein (Mr=50-60 kDa) on the surface of various cell types. This receptor can be bound by or cleaved by urokinase. The cleaved receptor, soluble urokinase-type plasminogen activator receptor (suPAR), with an Mr=35 kDa has no known physiological function and can be identified circulating in the blood of normal individuals. Although no function has been characterized, the soluble receptor has been reported to be of clinical significance. The objective of this study is to characterize novel serum markers that can be used for the early detection of prostate cancer and to predict patient prognosis. Thirty-nine patients at the University of Yaounde I, Yaounde, Cameroon, West Africa were examined for prostatic disorders. Of these, 46% were diagnosed with benign prostate hyperplasia (BPH), while 44% of the patients were diagnosed via biopsy with prostate cancer and graded accordingly. Here we show that serum from patients with BPH or prostate cancer contains elevated levels of suPAR. To examine the significance of suPAR as a diagnostic factor, we used a suPAR ELISA kit and compared these results with serum levels of prostate specific antigen (PSA), the current diagnostic marker for prostate cancer. PSA and serum suPAR levels in BPH and cancer patients were greatly elevated in the majority of patients, while others had undetectable levels of either. Serum levels of suPAR were high in cancer patients as well as, although to a lesser degree, in patients with BPH. Cancer patients who died during the follow-up period were found to have consistently higher serum suPAR levels than correlating serum PSA levels. These preliminary findings are the first evaluating serum suPAR levels as a possible diagnostic marker for the early detection of prostate cancer and for the prediction of patient prognosis.

Pediatric urolithiasis in sub-saharan Africa: a comparative study in two regions of Cameroon.

OBJECTIVE: To determine the composition of caculi and the predisposing factors for stone nucleation and growth in children from two regions of Cameroon. METHODS: This was a cross-sectional study involving 21 children, 17 from the northern and 4 from the southern region, over a 6-year period. Data on age, diet, residence, clinical presentation, location of stone, and results of stone analysis were collated following a preestablished proforma. A computerized analysis of the data was carried out. The constituents of stone sections and nidus were assembled so as to determine the principal causes of stone nucleation and growth. RESULTS: Pediatric urolithiasis was more common in the northern Sahelian belt of Cameroon. Males and rural dwellers were more commonly affected. Endemic (bladder) stone disease was found in the majority of the patients. All stones were mixed. The most frequent constituents of the stones were ammonium urate, struvites, and whewellite in descending order of percentage mean volume per stone. The nidus was available for study in only 10 stones, and its composition revealed heterogeneity of causes of nucleation. The commonest cause for stone formation and growth were infection and hyperuricosuria (malnutrition). CONCLUSIONS: Pediatric bladder stone disease is not uncommon in northern Cameroon. Many factors combined to predispose to stone nucleation and growth, but the level of socioeconomic development was preponderant. Stone composition indicated that urolithiasis in children was a heterogeneous disorder, but hyperuricosuria, insufficient diuresis, and infection associated with malnutrition seemed to be the most common causes.

Migration and prostate cancer: an international perspective.

There are intra- and interracial differences in prostate cancer incidence and mortality rates worldwide. The environment and migration patterns seem to influence the disparities in cancer statistics. The lowest incidence rate is recorded in Chinese, followed by other Asians, South Americans, southern Europeans, and northern Europeans, in ascending order. However, people of African descent have the highest incidence so far. Until recently, African Americans in Alameda County (California) in the United States had the highest reported incidence (160/1000,000). An incidence of 314/100,000 recently was reported in African Caribbeans from Jamaica. These high rates contrast with the low incidence rates reported in continental (Sub-Saharan) Africa. Angwafo et al have reported higher age-adjusted incidence rates in Yaounde, Cameroon (93.8/100,000). They highlighted the importance of diagnostic methodology, availability of and access to diagnostic techniques and trained manpower, and adjustments for the age distribution of populations when comparing incidence rates between regions. The great disparity in cancer statistics over large geographic areas and races has oriented studies toward genes and gene products susceptible to environmental risk factors such as diet, ultraviolet rays, and cadmium, which may be associated with or causative of prostate cancer. Randomized studies on suspected risk factors and promoters of prostate cancer need to be conducted worldwide. However, caution is in order when inferences are made comparing populations with access to health care to those without.

Migration and prostate cancer: an international perspective

There are intra- and interracial differences in prostrate cancer incidence and mortality rates worldwide. The environment and migration patterns seem to influence the disparities in cancer statistics. The lowest incidence rate is recorded in Chinese, followed by other Asians, South Americans, southern Europeans, and northern Europeans, in ascending order. However, people of African descent have the highest incidence so far. Until recently, African Americans in Alameda County (California) in the United States had the highest reported incidence (160/1000,000). An incidence of 314/100,000 recently was reported in African Caribbeans from Jamaica. These high rates contrast with the low incidence rates reported in continental (Sub-Saharan) Africa. Angwafo et al have reported higher age-adjusted incidence rates in Yaounde, Cameroon (93.8/100,000). They highlighted the importance of diagnostic techniques and trained manpower, and adjustments for the age distribution of populations when comparing incidence rates between regions. The great disparity in cancer statistics over large geographic areas and races has oriented studies toward genes and gene products susceptible to environmental risk factors such as diet, ultraviolet rays, and cadmium, which may be associated with or causative of prostate cancer. Randomized studies on suspected risk factors and promoters of prostrate cancer need to be conducted worldwide. However, caution is in order when inferences are made comparing populations with access to health care to those without. (Au)

Prostatic abscesses in sub-Saharan Africa: a hospital-based experience from Cameroon.

Abscesses of the prostate are encountered less frequently today and the bacteria responsible have changed over the years. Herein we report our experience with 6 patients with varying presentations. The role of imaging techniques in diagnosis and percutaneous needle aspiration of prostatic abscesses is highlighted.

Testes tumors in a Sub-Saharan African city (Yaounde). Incident cases and histopathology.

OBJECTIVES: To determine the histologic types of testicular tumors and identify associated risk factors. METHODS: Data on clinical presentation, age, race, history of cryptorchidism or testicular trauma and histologic types, on each patient with testis tumor, were abstracted from medical records and the pathology register. RESULTS: Of 14 tumors, 11 were malignant. Five were Burkitt's and 2 non-Burkitt's lymphomas, 1 plasmocytoma and 3 seminomas. None of the seminomas occurred in black Africans. CONCLUSION: The epidemiology and histology of testis tumors in Yaounde differs considerably from other reported series. Burkitt's lymphoma is the commonest tumor. This alters the approach to the management of testicular masses. Race and geography seem to be important in the occurrence of testes tumors.

Interet du traitement chirurgical de la cryptorchidie a Yaounde

Une etude retrospective visant a evaluer l'interet du traitement chirurgical de la cryptorchidie a porte sur 123 patients operes a Yaounde pendant une periode de 10 ans allant de 1984 a 1994. L'analyse a revele que 93 patients (75;6 pour cent) avaient ete operes apres l'age de trois ans; au moment ou des alterations histologiques avaient deja compris le pronostic fonctionnel du testicule et augmente le risque de cancerisation. Des resultats comparables dans la litterature montrent l'insuffisance de l'information medicale sur l'age optimal de l'abaissement des testicules cryptorchides. L'etude fait des propositions pour un changement de comportement

[Rare association of a non-functional retroperitoneal paraganglioma and nephrotic syndrome]. / Association rare d'un paragangliome rétropéritonéal non fonctionnel et d'un syndrome néphrotique.

Non functional retroperitoneal paragangliomas are rare: less than 50 cases in literature. They are usually asymptomatic and can attain reasonable dimensions. The association with nephrotic syndrome is exceptional. The authors report a clinical observation of non-functional paraganglioma in a 45 year old woman, with repeated surgical abstention. Literature was reviewed and therapeutic indications discussed.

[Prostatic tumors (adenoma, adenocarcinoma) and obesity in Cameroon]. / Tumeurs de la prostate (adénomes, adénocarcinomes) et obésité en milieu camerounais.

The aim of this study was to look for an association between obesity and prostatic tumors in general in Cameroon. During a sixteen month period (1 September 1991 to 31 December 1992), we recruited 50 symptomatic patients with histologically confirmed prostatic tumors who were matched with a control of the same age. Of these patients, 36 had adenomas, 12 had carcinomas, two had both tumors. Patients' age ranged from 49 to 91 years. The difference in body weight and height between the patients and the controls was not significant. According to the Lorentz formula, there were as many obese patients as controls. Obesity was five times more frequent in the patients than the controls following the body mass index, but this difference was not significant. We conclude that in our area, there might be an association between obesity and prostatic tumors in general but our study is too small to reach a conclusion.

[Posterior urethral valves in children. Apropos of 22 cases]. / Les valves de l'urètre postérieur chez l'enfant. A propos de 22 cas.

We reviewed 22 cases of posterior urethral valves over a five year period (January 1986 to December 1990). We looked at initial management before referral to the urologist, treatment and those factors that influence the outcome. We found that nosocomial infection from catheters was the major source of morbidity and mortality. Other determinants of outcome included postobstructive diuresis and the presence of refluxing or obstructing megaureters. The age of the patients was not as important as the degree of obstruction in this group of patients. We recommend percutaneous cystostomy as initial management for these patients as opposed to urethral catheterisation. This should be followed by antegrade or retrograde valve ablation one week later depending on the size of urethra.

[Late exterioration of a postoperative cecal fistula in children. Apropos of a rare clinical case]. / Fistule caecale postopératoire tardivement extériorisée chez l'enfant. A propos d'une observation clinique rare.

The authors report a rare clinical observation of a post-appendectomy caecal fistula retardedly exteriorized, in a 18 year old adolescent, managed in the surgical service of the Yaounde General Hospital. The radical treatment was surgical and consisted in right hemicolectomy. Literature was reviewed and therapeutic indications discussed.