[Obstetrical vesico-vaginal fistula in Guinea: Data analysis of three sites of treatment at Engender Health ONG]. / Fistules vésico-vaginales obstétricales en Guinée : analyse des données de 3 sites de prise en charge de l'ONG Engender Health.

OBJECTIVE: To analyze the management of obstetric vesico-vaginal fistula in the three sites of Engender Health in Guinea. PATIENTS AND METHODS: It was a retrospective study of descriptive type having helped collect 450 cases of vesico-vaginal fistulas in three support sites engender health between January 2008 and December 2011. The variables studied were epidemiological, clinical and therapeutic reasons and treatment outcomes were evaluated after a decline of at least six months. RESULTS: The mean age of onset of the fistula was 25years, ranging from 12 to 55years and 58.8% (n=265) of patients were aged between 18 and 30years. The mean duration of fistula was 11years, ranging from 1 to 38years. Eighty-two percent (n=416) of patients were housewives and 66.4% (n=299) off school. The complex fistula with 66% (n=297) was the most frequent. The treatment consisted of a fistulorraphie after splitting vesico-vaginal in 93.3% (n=420) of cases. Therapeutic results considered after a mean of 8months have resulted in a cure in 79.3% (n=357) of cases, improvement in 4.2% (n=19) of cases and failure in 16 4% (n=74) of cases. CONCLUSION: Vesico-vaginal fistula is a major cause of maternal morbidity in Guinea. The establishment of a real health policy based on sound medical and social structures contributes to its eradication. LEVEL OF EVIDENCE: 5.

[The profile urological emergencies at the Conakry University Teaching Hospital, Guinea]. / Le profil des urgences urologiques au CHU de Conakry, Guinée.

OBJECTIVE: To stick out the profile urological emergencies at the Conakry University Teaching Hospital, Guinea. PATIENTS AND METHODS: This retrospective study, carried out over a period of 3 years (January 2005-December 2007), included 757 urological emergencies admitted to the urology department of the university hospital of Conakry, Guinea. RESULTS: The mean age of patients was 56 years. These patients had an age equal to or higher than 60 years in 58% of the cases. The sex ratio (M/F) was 16.6. According to the social profession, the farmer (40,6%) and workers (21%) were the dominant patients. The most frequent illness was vesical urinary retention (73.9%), hematuria (9.6%) and genito-urinary system trauma (7%). The most performed procedures were the installation of a urethral catheter (55.25%) and the installation of a suprapubic catheter (24.14%). CONCLUSION: The most frequent urological emergency in our country was vesical urinary retention, the hematuria and genito-urinary system trauma are not rare there.

[Intensive care management of HELLP syndrome in Dakar]. / Prise en charge du HELLP syndrome en réanimation à Dakar.

OBJECTIVE: To evaluate the intensive management of HELLP syndrome in a intensive care unit in African setting. STUDY DESIGN: Descriptive and analytical retrospective study. PATIENTS AND METHODS: All patients hospitalized between June 1998 and June 2004 for HELLP syndrome were included in the study. Following parameters were studied: age, parity and gestity, term of pregnancy, delay before admission in ICU, data clinical, biological parameters, medical treatment, obstetrical treatment, maternal complications, maternal and foetal prognosis. RESULTS: Twenty patients of average age 26.3 years with seven primigeste and 13 pauci and miltigeste were admitted in ICU during the period of study for HELLP syndrome. The average time of admission was 1.35 days; 13 patients had HELLP syndrome in ante partum and seven patients in postpartum. Serious complications were noted at admission in the majority of patients with oligoanuric renal insufficiency in 11 cases, eclampsia in eight cases and intravascular coagulation disseminated in four cases. The mode of delivery in patients for HELLP syndrome occurring in ante partum was the Caesarean section under general anaesthesia in five cases and vaginal delivery in eight cases. All the patients for HELLP syndrome in the postpartum had been confined by low way. The maternal evolution was favourable in 13 cases. Seven patients of which five with HELLP syndrome who occurred in ante partum had died. The infant mortality was noted in eight cases primarily in cases of HELLP syndrome which occurred in ante partum.

[Nosocomial ventilator-associated pneumonia in a tropical intensive care unit]. / Pneumopathies nosocomialesacquises sous ventilation mécanique dans un service de réanimation en milieu tropical.

INTRODUCTION: Nosocomial ventilator-associated pneumonia (VAP) occupy an important place among nosocomial infections and are responsible for a very high mortality. The objective of this work was to study epidemiologic, diagnostic and therapeutic aspects of ventilator-associated pneumonia in a tropical Intensive Care Unit and to release an adapted strategy of antimicrobial treatment. PATIENTS AND METHODS: It is a prospective descriptive study carried out from January to December 2002 in the polyvalent intensive care unit, in collaboration with the laboratory of bacteriology-virology of the CHU Dantec of Dakar. We included all the patients admitted and who presented radiological pulmonary infiltrates appearing after 48 hours of mechanical ventilation, associated to at least 2 clinic or biologic criteria and to a positive tracheal aspirate with a cut off value of 10(4) CFU/ml. RESULTS: Thirty two cases of VAP have been diagnosed among 446 patients admitted in our ICU. The incidence was 7.16 per 100 admitted patients and 50 per 100 ventilated patients. The reasons for ICU admission were dominated by trauma (44%). Microorganisms responsible of VAP were essentially Gram negative bacilli (GNB), 68% with in head the Pseudomonas. Acinetobacter strains were practically resistant to all usually used antibiotics. The more used antibiotics were gentamicine, 3rd generation cephalosporins and fluoroquinolones. Antibiotic treatment was appropriate in only 13 cases in 26 patients at whom intrinsic antibacterial activities of antimicrobial agents were examined. The mortality rate was of 81%. CONCLUSION: The improvement of the prognosis of these VAP require preventive measures with protocols of care, a qualified staff, diagnostic means and active antibiotics on the responsible pathogens.

[Diabetic ketoacidosis of the child revealed by a pseudo-surgical acute abdomen. A case report]. / Acidocétose diabétique de l'enfant révélée par un tableau d'abdomen aigu pseudo-chirurgical: a propos d'un cas.

Ketoacidosis is a frequent mode of revelation of diabetes of the child. Signs of diabetes are generally unperceived or are badly interpreted by the family entourage. We report a case of diabetic ketoacidosis in an eight-year-old child without particular medical history. The context of discovery was an acute abdomen by gastric dilatation in a severe context of dehydration. Evolution was quickly favourable after medical treatment with disappearance of acute abdominal signs (clinical and radiological). This observation enables us to recall, by the light of a review of the literature, that diabetic ketoacidosis can be revealed by pseudo-surgical acute abdomen and treatment is purely medical.

[Epidemiologic and obstetric aspects of adolescent pregnancies in the hospital milieu]. / Aspects épidémiologiques et obstétricaux de la gravidopuerpéralité des adolescentes en milieu hospitalier.

Adolescence is a period of change where the person is seeking an identity. This period is characterized by an early sexuality with early pregnancies and risky deliveries. The objectives of our study are to show the epidemiologic aspects of adolescent pregnancy and to identify its obstetrical factors. It is a prospective study held in one year, from August 1st 1991 to July 31 1992 including all pregnant adolescents and those coming for delivery at the Obstetrics and Gynecology clinic at the University teaching hospital Le Dantec. The prevalence of adolescent pregnancy is 3.7% and 84% are primiparous. The non-educated represent 65% and 55% are married. Early sexuality and early pregnancy are mostly seen among Pulars. The complications during pregnancy are toxemia and its accidents (17.6%), premature rupture of membrane (4.4%) and anemia (2.5%). Adolescent who had not received prenatal care represent 11% and 38% had not received enough care. Normal delivery happened in 67.5% and the C-section represented 7.5%. 3% of the adolescents had done unsafe abortion. No maternal death was observed. 89.1% live births were reported, however, 18.4% needed intensive care. Because of the obstetric and neonatal problems, early pregnancy should be prevented through a active collaboration of divers partners.

Risk factors for maternal mortality: a case-control study in Dakar hospitals (Senegal).

This study was conducted in the three main hospitals of Dakar, the capital city of Senegal. Each case of 152 maternal deaths identified over a 12-month period was matched with two controls: a safe delivery in the same clinic, and a safe delivery in the same neighbourhood of residence. Controls were matched on age, birth order, place, and time of delivery. The leading causes of death were: puerperal sepsis and other infections (51 cases), haemorrhage (32 cases), eclampsia (29 cases), ruptured uterus (11 cases), and anaemia (7 cases). Results of the case-control study revealed the major risk factors associated with health system failures: medical equipment failure (odds ratio [OR] = 55.0), late referral (OR = 23.2), lack of antenatal visit (OR = 16.9), and lack of available personnel at time of admission (OR = 6.6). Various indicators of maternal status at time of admission (complications, blood pressure, temperature, oedema, haemoglobin level) and of health history prior to admission (previous complications, previous C-section, lack of treatment) were also strong predictors of survival. Lastly, socio-demographic factors also appeared as correlates of maternal mortality, in particular: first pregnancy (OR = 2.3), pregnancy of high birth order (OR = 1.9), rainy season (OR = 2.4), being unmarried (OR = 2.5), and low level of education (OR = 1.6). Implications for policy are discussed.

[Vaginal injuries during coitus: 98 cases]. / Les blessures vaginales au cours du coït: une série de 98 cas.

UNLABELLED: We have undertaken a prospective study of vaginal injuries due to coitus with the aim of evaluating their incidence, risk factors and anatomic lesions. Over a period of 39 months, 98 cases were found, giving a monthly incidence of 2.5. The patients had a mean age of 25 years, were paucipara in more than 50%. Sexual abstience was found in 72 cases with a mean duration of 6 months. This injury occurred more often in gynecological period than in the postpartum (77 cases versus 22). During sexual intercourse the most harmful position was when the patient was in dorsal decubitus with maximum flexion and abduction of the limbs. The vaginal injury was located in the posterior cul de sac in 39 cases and was of 5 cm of length in 56%. Surgical suture was required in 92 out of 98 patients, in combination with local and general antibiotics. CONCLUSION: Vaginal injuries due to coitus are frequent in our practice and they create serious anatomic lesions. So there is a need to precise the etiopathogenicity (hormonal deficiency ?, infections ?, role of the male partner) and to evaluate the long term sequellas.

[Epidemiological and anatomo-clinical features of extra-uterine pregnancies at the Dakar University Hospital Center]. / Aspects épidémiologiques et anatomo-cliniques des grossesses extra-utérines (G.E.U.) au CHU de Dakar.

It is the prospective study of 226 cases of operated ectopic pregnancies, in order to draw the epidemiological outline of such an affliction adn find out the possible etiologies. During this study, 107 swabs were anatomically exploited. An analysis of the results reveals the high frequency of disrupted ectopic pregnancies (over 90%). The ampullary localization exists in 73.45% of the cases. In the histological level, in 82.70 of the cases, the tubal pregnancy has been associated with a salpingitis or malformed lesions. The death rate is about 2.65%. In other respects, it appears that the limits of echography are actual, hence the importance of basic clinic, that mutilating surgery remains prevalent; histology also plays an unavoidable part in the diagnosis.

[Paroxystic complications in vasculo-renal syndromes during pregnancy and puerperium at the CHU of Dakar]. / Les accidents paroxystiques des syndromes vasculo-rénaux au cours de la gravido-puerpéralité au CHU de Dakar.

In a comparative study issued in 1989 in Gynecology in Dantec (a Medical Hospital School) in Dakar (Senegal), the authors made a retrospective analysis of 206 cases of abruptio placenta (3.3%) and 56 cases of eclampsia (0.9%). After a physiopathologic overview of the vascular renal syndromes, they point out the risk factors of paroxistic accidents represented mainly by the age and the parity, knowing that young age and primiparity appear as new risk factors for abruptio placenta. Finally, they insisted on the prevention of these accidents because of their impact on fetal and maternal mortalities.

[Diabetic pregnancy in Senegal (years 1980 to 1989)]. / La grossesse diabétique au Sénégal (Années 1980 à 1989).

INTRODUCTION AND OBJECTIVES: Diabetic Pregnancy Prognosis in Seventies is it better in Eighties because of Patient Education? METHODOLOGY: Retrospectively, since 1980 to 1989, in Women in status to breed, Diabetic Pregnancy was screened in our Department. W.H.O.'s (1980) Diabetes Mellitus Criterias, PEDERSEN's Criterias, White's Classification were used. Studied Parameters were etiologic factors (age, type, Diabetes oldness and control), former and present Evolution of Pregnancies (term and pregnancy's product). RESULTS: A--In Global Study, 15.07% Diabetic Pregnancies were observed: 22 (37%) Insulin Dependent and 38 (63%) Non Insulin Dependent. The global mean of age was 31 years; Diabetic Mellitus was less than 10 years old in 90% cases whatever the type. Their control was not good (Glycemic Control < 1.4 g/l in less than 50%). Diabetes complications were nephropathy (13.6% and 8%), retinopathy (13.6% and 18.5%), arterial hypertension (0% and 26.32%), cetoacidosis (31.42% and 0%), urinary tract infection (18% and 0%) respectively in Insulin Dependent and Non Insulin Dependent Pregnancies. Near a third (31.6%) of Insulin Dependent and a third (33.41%) for Non Insulin Dependent were of D, F, H White's Class. Multipares were often Non Insulin Dependent and inversely Insulin Dependent frequently paucipare. Former Pregnancies had near 25.5% interrupted term in Insulin Dependents. Present Pregnancies have given 28.5% and 32% of Normal Children: 14.25 and 12% of Abortions and 14.25% and 6% of Spontaneous Premature Parturitions respectively in Insulin Dependents and Non Insulin Dependents. B--In Analytic Study of Foetopathies, bad Prognosis Factors were high Maternal Age, Multiparity, bad Glycemic Control whatever Diabetes type. For Insulin Dependent, Negligency was added and for Non Insulin Dependent, Obesity, Arterial Hypertension and all PBSP. DISCUSSION AND CONCLUSION: A relatively mild Diabetic Pregnancy Prognosis in our areas with limited means has been observed despite of Patients Education.

Pronostic maternel et foetal et facteurs de risque lies au mode de vie

Les auteurs; dans une etude prospective; font ressortir le role des habitudes coutumes et traditions dans le deces maternel et la mortinatalite. Ils montrent que ces deux indicateurs apprecient bien la qualite de la surveillance de la grossesse et du travail d'accouchement. Ils insistent alors sur la place qui revient a l'education pour la sante dans la prevention de cette tragedie

[Antithrombin ii in eclampsia: estimation of predictive value]. / Antithrombine III dans l'éclampsie: estimation d'un seuil prédictionnel.

We have observed in our study that antithrombin III activity decreases very significatively in eclampsia (p < 0.0001). A level of 90% was defined as a threshold. All the rates which are under or equal to 90% have 78.3% as a positive predictive value and those over 90% have a 98.7% as a negative predictive value for the overcoming of eclampsia. We have concluded that the 90% antithrombin III activity represents the alarm level for over coming eclamptic crises. The determination of the antithrombin III activity must be systematically done in every hypertensive pregnancy with proteinuria.

[Borreliosis and pregnancy. (Review of the literature apropos of 1 case)]. / Borreliose et grossesse (revue de la littérature à propos d'un cas).

It exists, essentially, in two, epidemiological forms: recurrent fever (FR) carried by fleas, resulting in wide scale epidemics; recurrent fever carried by ticks (soft ticks) of the ornithodorus type which results in localized, endemo-sporadic manifestations throughout the world. The second type is the main one in these regions, but the first is not uncommon. The report covers a peculiar case of flea-borne borreliosis occurring in a pregnant woman and associated with the presence of HBS antigen and plasmodium falciparum malaria. Although the review of literature is not exhaustive, the affliction, notably its obstetric implications, are highlighted.

[Hydatid cyst of the uterus (apropos of a case seen at the gynecologic and obstetrical clinic of the C.H.U. of Dakar)]. / Kyste hydatique de l'utérus (a propos d'un cas observé à la clinique gynécologique et obstétricale du C.H.U. de Dakar.

Hydatic Cysts, or Hydatidosis, is the result of an intermediary host to VON SIEBOLD's Taenia Echinococcus larva turning into a cyst within the organism. Hydatic sickness combines all the toxic and allergic symptoms produced by the hydatic cyst. Echinococcosis is the anthropozoonosis of parasitic origin responsible for repercussions on the organism, development of the hydatic cyst and the hydatic sickness. It can come from dogs, sheep or cattle or, exceptionally, humans. Based on a case of hydatic cyst in the uterus, the authors underline gyneco-obstetrical aspects of the affliction. They recall diagnostic difficulties which may occur outside the endemic zones this very rare localization, and propose a practical solution based on echography.

[Acute hemorrhagic pancreatitis and pregnancy: report of a case]. / Pancréatite aiguë hémorragique et grossesse: à propos d'un cas.

The etiological characteristics of one case of acute, necrotic haemorrhagic pancreatitis linked with pregnancy are stressed, as are the difficulties of diagnosis accentuated by poor laboratory conditions, even for emergency cases. Hence, this combination is, unfortunately, found in the hospitals, usually in the course of systematic, necropsy verification.

Cyclic AMP regulation of fuel metabolism during exercise: regulation of adipose tissue lipolysis during exercise.

Adipocytes from trained rats release more free fatty acids in response to hormonal challenge compared to fat cells from sedentary rats. Lipolysis results from increased triglyceride hydrolysis that is catalyzed by a hormone-sensitive lipase, which, in turn, is activated by a phosphorylation mechanism involving cyclic AMP-dependent protein kinase. Cyclic AMP levels within the fat cell are regulated by beta-adrenergic receptor/adenylate cyclase interactions and cyclic AMP phosphodiesterase activity. This review focuses on cyclic AMP regulation of lipolysis in adipocytes from trained and sedentary animals. Although lipolysis is elevated in fat cells from trained rats, no differences are found in beta-adrenergic receptor number or affinity, adenylate cyclase activity, protein kinase activity, or partially purified hormone-sensitive lipase activity when compared to sedentary rats. The major lipolytic alteration induced by exercise training appears to occur at a site distal to hormonal regulation of the beta-adrenergic receptor.

Enhanced lipolysis is not evident in adipocytes from exercise-trained SHR.

Adipocytes from spontaneously hypertensive rats (SHR) are not as responsive to isoproterenol or dibutyryl adenosine 3',5'-cyclic monophosphate (cAMP) stimulation compared with Sprague-Dawley or Wistar-Kyoto rats. Lipolytic activity in adipocytes from trained normotensive rats was enhanced in response to 1 microM isoproterenol and 0.5 mM dibutyryl cAMP but not in adipocytes from trained SHR. Decreases in isoproterenol-stimulated (1 microM) cAMP accumulation were evident in adipocytes from trained normotensive rats but not in adipocytes from trained SHR. Basal and agonist-induced lipolysis in fat cells isolated from both normotensive rats and SHR immediately following a 60-min run was increased in both sedentary and trained rats. Adenylate cyclase activity in fat cell membranes was blunted in sedentary and trained SHR both in the absence and presence of 100 microM 5'-guanylyl imidophosphate. No apparent differences existed in antagonist affinity of binding sites for the antagonist dihydroalprenolol in normal rats or SHR. Evidence for a change in affinity of agonist isoproterenol might be indicated based on the enhanced potency of isoproterenol to stimulate lipolysis in trained normal rats. beta-Adrenergic receptor density and antagonist affinity were not different in normotensive rats and SHR in response to training. However, displacement of [3H]dihydroalprenolol in adipocytes from SHR required greater concentrations of isoproterenol compared with adipocytes from normotensive rats, further suggestive of increased agonist affinity of binding sites in normal rats. These data suggest a postreceptor lesion of the lipolytic pathway in adipocytes from spontaneously hypertensive rats, possibly at the guanine nucleotide regulatory protein level.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cerebrovascular complications of oral contraceptives. Review of the literature; report of 2 cases]. / Complications cerebro-vasculaires des contraceptifs oraux. Revue de la litterature (a propos de 2 observations).

PIP: 2 cases of cerebrovascular complications of oral contraceptives (OCs) and results of a literature review are described in the hope of alerting other practitioners to the need for careful patient evaluation before OCs are prescribed. A 32 year old multipara with a 2 year history of Gynovlane use suffered a complete occlusion of the carotid artery, probably of embolic origin. A 20 year old mother of 1 child with a 1-year history of Gynovlane use was diagnosed as suffering an ischemic vascular accident in the area of the left ophthalmic artery. Cerebral vascular accidents appear to be rare in OC users; about 1 in 10,000 users on a worldwide basis is afflicted, but unfortunately about 5-10% are fatal. Women of any age may be affected, but the incidence increases in women over 35 years, whose mortality rate is 4 times greater. White women according to 1 author are more at risk than black women. All types of pills may be involved, but the risk appears to be partly a function of the presence and dosage of estrogen. Cerebrovascular accidents have become rare since the advent of lower dosed pills. The duration of pill use before the occurence of the accident varies, but venous thromboses appear to occur earlier than arterial accidents. Factors favoring occurrence of cerebrovascular accidents in women using pills depend on the type of accident. Age, smoking, hyperlipidemia, surgical interventions, and a history of migraines are implicated in arterial thromboses. Surgical interventions, prolonged immobility due to fracture, and preexisting venous conditions are implicated in venous thromboses. The severity of hormone-induced cerebrovascular accidents confers great importance on prevention. No test exists to identify women at highest risk, so that prevention requires careful screening of OC candidates for risk factors. Treatment of cerebrovascular accidents and their sequelae is usually based on anticoagulants and heparin. Systematic functional rehabilitation is necessary in cases of invalidism. Termination of OC use is necessary in all cases at the least sign of trouble.^ieng