Les ruptures uterines au cours du travail; observees au CHUA/GOB Antananarivo Madagascar

La rupture uterine; urgence obstetricale majeure; a fait l'objet d'une etude retrospective au niveau du Centre Hospitalier Universitaire d'Antananarivo; Gynecologie-Obstetrique de Befelatanana (CHUA/GOB) en 2006.Trente-six ont ete enregistres sur 7152 accouchements; soit une rupture pour 199 accouchements. Le profil moyen est celui d'une femme agee de 25 ans a 36 ans (n=20 ; 55;5); multipare (n=22 ; 61;1) et habitant en zone rurale (n=25 ; 69;4). La plupart des gestantes n'ont pas beneficie d'une consultation prenatale reguliere (n=26 ; 72;2). La suture uterine a ete realisee dans 60;9des cas (n=23). Le pronostic etait marque par une mortalite prenatale tres elevee

[Value of vesical filling for umbilical cord prolapse. Description of a 14-case series at the Befelatanana University hospital center maternity unit (Antananarivo, Madagascar)]. / Intérêt du remplissage vésical au cours des procidences du cordon ombilical pulsatile. A propos de 14 cas observés à la maternité du CHUA de Befelatanana (Antananarivo-Madagascar).

Umbilical cord prolapse occurs when the umbilical cord drops through the open cervix into the vagina ahead of the baby, after spontaneous or artificial rupture of the membrane. It is a severe obstetrical emergency that endangers the life of the baby due to compression of the cord. Since the 1980s, bladder filling has been recommended as a simple and effective technique for reducing foetal mortality even if surgery cannot be undertaken immediately. The purpose of this study was to report experience using the bladder filling technique at the Gynaecology-Obstetrics Unit in Befelatanana (Antananarivo University Hospital Center). These results confirm the reliability and effectiveness as previously reported in the literature. Because of its simplicity and efficacy in reducing the risk for the foetus, bladder filling should be taught and used particularly in countries with limited obstetrical facilities.

[Hemoperitoneum caused by traumatic rupture of mesenteric lymphangioma cyst. Case report from Madagascar]. / Hémopéritoine par rupture post-traumatique d'un lymphangiome kystique mésentérique: à propos d'une observation à Madagascar.

Mesenteric cystic lymphangioma is an uncommon benign tumor. The purpose of this report is to present a case involving a 7-year-old girl who presented hemoperitoneum due to traumatic rupture of a mesenteric lymphangioma cyst. The patient who had a huge preexisting tumor mass presented with hemorrhagic shock symptoms following a severe fall. Peritoneum puncture lavage confirmed hemoperitoneum. Exploratory laparotomy revealed a large bleeding cyst-like mesenteric tumor. Total extirpation was difficult but successful. Histological examination of the surgical specimen demonstrated mesenteric lymphangioma. In developing countries like Madagascar, rupture of parasitic splenic cysts is the most frequent underlying etiology in children presenting hemorrhagic syndrome after falls. This case shows that mesenteric cystic lymphangioma rupture can be a rare cause.

Interet du remplissage vesical au cours des procidences du cordon ombilical pulsatile a propos de 14 cas observes a la maternite du CHUA de Befelatanana (Antananarivo- Madagascar)

La procidence du cordon ombilical ou chute de celui-ci en avant de la presentation apres rupture spontanee ou artificielle de la poche des eaux constitue une extreme urgence obstetricale par le risque majeur de mortalite perinatale qu'il represente. La technique du remplissage vesical decrite depuis les annees 80 est unmoyen simple; efficace de reduction du risque de deces foetal; meme en cas de retard a la sanction chirurgicale. L'objectif de notre etude est de rapporter l'experience du service de Gynecologie Obstetrique de Befelatanana (CHU d'Antananarivo) sur cette technique; qui prouve sa fiabilite et son interet par des resultats identiques a ceux de la litterature. Sa simplicite de mise en oeuvre et son efficacite sur le risque foetal merite; tout particulierement dans les pays a faible infrastructure obstetricale; d'etre enseignee et utilisee

[Neglected shoulders reported at the Befelatanana Maternity Hospital (Antananarivo, Madagascar)]. / Les épaules négligées vues à la maternité de Befelatanana à Antananarivo, Madagascar.

We conducted a retrospective study on neglected shoulders during 12 months at the Maternity Hospital of Befelatanana, 31 cases among 4685 deliveries were reported. The majority of the pregnancies are not under medical supervision and no ultrasound is carried out during the third trimester. There were 8 cases of uterine rupture, 2 haemorrhage shocks, 6 syndromes of prerupture, 6 umbilical cord prolapses at the third degree and 6 tears of the cervix. 20 caesarean sections have been performed as well as a turning of foetus in utero in 3 women, 4 hysterectomies, and a conservative suture with uterine tube ligation in the other cases. Often linked to a large multiparity the neglected shoulder remains quite frequent in developing countries such as Madagascar and regular prenatal consultations together with a rigorous clinical exam are highly recommended by the authors to make an early diagnosis and provide a better care management.

[Female genital tuberculosis: about 11 cases treated in Antananarivo (Madagascar)]. / La tuberculose génitale chez la femme: à propos de 11 cas suivis à Antananarivo, Madagascar.

A 5 year prospective study on genital tuberculosis, a rather uncommon localization, has been undertaken in 11 women treated at the DAT-HIS of Antananarivo, Madagascar Clinical diagnosis is problematic, if not unfeasible, due to the polymorphism of genital tuberculosis in women. Only histological and bacteriological examinations are, so far, confirmatory In the future, recourse to polymerase chain reaction will facilitate diagnosis and will allow a more accurate assessment of the incidence of this aspect of tuberculosis infection. Genital tuberculosis compromises women's fertility Even though the tuberculosis is cured, none of the 11 women of our research had carried their pregnancy to delivery, because artificial fertilization is not feasible here in Madagascar Screening of woman genital tuberculosis should be mandatory as regards gynaecological problems such as menstrual cycle disorders, sterility, abdominal pain, cyst of ovary ectopic pregnancy, spontaneous miscarriage in paraclinical investigations, especially in developing countries.

[Kidney cancer in horseshoe kidney. A case report of an unexpected diagnosis]. / Cancer sur rein en fer à cheval. A propos d'un cas de découverte fortuite.

The authors report a case of renal cell carcinoma in a horseshoe kidney and discuss diagnostic and therapeutical aspects arising from this combination. Renal carcinoid tumors and nephroblastoma seems to be more frequent in this malformation. Diagnosis of horseshoe kidney may be difficult and angiography examination is very useful to confirm renal anomaly, tumor situation, and to plan the surgical approach because vascularization vary case to case. Heminephrectomy adapted to neoplasic localisation remains the essential treatment.

[Unusual testicular tumor: an ectopic spleen]. / Tumeur testiculaire inhabituelle: une rate ectopique.

The authors report a case of discontinuous splenogonadal fusion diagnosed after left orchidectomy. Ectopic spleen in the scrotum is a rare congential anomaly frequently associated with other anomalies, especially limb defects. The diagnosis is difficult. Preoperative isotope scanning and intraoperative pathological examination can be performed to avoid unnecessary orchidectomy.

[Oriental biliary lithiasis. Retrospective study of 690 patients treated surgically over 8 years at Hospital 108 in Hanoi (Vietnam)]. / Les lithiases biliaires extrême-orientales. Etude rétrospective sur 690 patients opérés en 8 ans d'activité à l'Hôpital 108 de Hanoi (Vietnam).

The purpose of this study was to review the unique features distinguishing Oriental from Western gallbladder disease based on a series of 690 patient who underwent surgical treatment at hospital 108 in Hanoi. Oriental cholangiohepatitis often affects in young patients with no gender predilection. The disease originates mainly in canaliculi and leads to blockage or obstruction of the main bile duct inside and outside the liver. Onset has been related to nutritional, infectious, and parasitic factors. Ascariasis may play a determinant role. Because of these unique features, surgical treatment is usually focused on the main bile duct and depends on the size, number, and effects of gallstones. The authors recall that excision of liver tissue may be unavoidable in some cases due to the severity and consequences of lithiasis.

[Value of the bilio-intestinal bypass in biliary disease in the Far East: retrospective study of 5 year experience at the Calmette Hospital of Phnom Penh (Cambodia)]. / Intérêt de la dérivation bilio-digestive dans la pathologie biliaire Extrême-Orientale: étude rétrospective sur 5 ans à l'Hôpital Calmette de Phnom Penh (Royaume du Cambodge).

Gallstone disease in the Far East exhibits a number of special features regarding epidemiology and etiology as well as indications for and response to surgical treatment. Surgical bypass techniques seldom used for treatment of gallstone disease in the West can be highly effective in lowering complication and recurrence rates in oriental patients. The purpose of this retrospective report is to describe a 5-year experience with gallstone disease at the Calmette Hospital in Phnom Penh (Kingdom of Cambodia). After reviewing the main pathological features encountered, we describe the indications for the two bypass techniques used. Choledocoduodenostomy was used for frail, elderly patients while choledochojejunostomy was the treatment of choice and achieved excellent short, middle, and long-term results in younger patients.

[Cambodia: creation of a university hospital center at Calmette Hospital. A new start for french medical cooperation?]. / Cambodge: création d'un Centre Hospitalier Universitaire à l'Hopital Calmette. Nouveau départ de la coopération médicale française?

In Cambodia, reconstruction of the hospital facilities remaining after the widespread destruction of the health system that occurred in 1970 has been under way since 1990. France has officially committed itself to re-organizing the Cambodian health care system and is playing a leading role in several projects. Technical assistance is provided at the Calmette Hospital, which provides not only practical training but also as a wide range of medical services with a 220-bed facility including medical departments, surgical departments, an intensive care department and a surgical theater. The objective is to reorganize the facility, update the training of staff and the available technology, and currently create an emergency care department. At the combined Faculty of Medicine, Pharmacy, and Odontology, restructuring is being managed by the French adviser to Dean who is in charge of training faculty and improving the quality of instruction which implies the assistance from French university professors. At the beginning of 1995, a new Pasteur Institute will open. The Calmette Hospital, the combined Faculty and the PASTEUR Institute constitute the University Hospital Center in Cambodia.

Enquete prospective sur les grossesses extra-uterines en Afrique tropicale. [Resume]

A propos d'une enquete prospective de six mois dans quelques centres hospitaliers d'Afrique intertropicale; les auteurs analysent 107 nouvelles observations de grossesses extra-uterines. Le profil de la candidate a cette pathologie reste superposable a celui des femmes atteintes de maladies sexuellement transmissibles: un age moyen de 25 ans; plus de deux enfants et difficultes d'acces aux soins. Dans les trois-quarts des observations; les alterations tubulaires sont dues a des lesions non specifiques comme dans les maladies sexuellement transmissibles. La prevention de ces affections reste donc la grande priorite et passe surtout par l'education de la population

Conduite a tenir dans les maladies sexuellement transmissibles. [Resume]

Les auteurs a propos de leur experience et de tres nombreuses etudes recentes proposent une conduite a tenir pratique face aux maladies sexuellement transmissibles; a l'exclusion du SIDA. Les maladies sont presentees selon leur symptomatologie: soit infection evidente lors des cervico-vaginites bruyantes; des ulcerations douloureuses ou non et formations tumorales; mais aussi au cours des salpingites et les sterilites. Ils insistent particulierement sur les manifestations cervico-vaginales qui correspondent a une consultation sur trois dans les services de gynecologie; en rappelant pour chaque affection leurs manifestations cliniques; leur possibilite diagnostique et leur traitement efficace. Toutes ces demarches; effectuees par le clinicien; doivent tenir compte de l'ambiance particuliere habituellement observee au cours des MST en Afrique tropicale: association multiple des germes; maladies vues a un stade deja tres evolue; difficulte therapeutique avec choix preferentiel pour les medicaments parenteraux et traitement de tous les partenaires. La prevention passe avant tout par une large information de la population