Characteristics of patients and patterns of chronic venous disease of the lower limbs in a referral hospital in Cameroon.

OBJECTIVE: The objective of this study was to investigate the magnitude of chronic venous disease (CVD) in sub-Saharan Africa, specifically the characteristics of the patients, the symptoms, the signs, and the severity. METHODS: From December 2013 to December 2016, a cross-sectional study was conducted of all consecutive patients with CVD aged ≥18 years and attending the outpatient clinic of the Yaoundé General Hospital in Cameroon. We recorded information on demographics, relevant medical history, symptoms, lifestyle, and clinical presentation. A duplex ultrasound examination investigated veins to seek obstruction and reflux (duration ≥0.5 second). The full Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification was used to describe CVD, and severity was assessed by the Venous Clinical Severity Score (VCSS). Statistical significance was at P < .05. RESULTS: Altogether, 319 patients (503 affected legs) were enrolled; 54.3% of patients were men with a mean age of 44.5 years (18-85 years) and CVD duration of 3 months to 45 years (mean, 2.3 years). Patients had such risk factors as obesity (32.6%), family history of CVD (17.7%), multiparity, and lifestyle requiring long standing periods (64.8%). Only 15% of women older than 49 years were using birth control pills, and none older than 49 years were receiving hormone replacement therapy. Only 42.9% of patients had previously been treated for CVD, mainly with venoactive drugs (34.1%). Of the 503 legs, 366 (72.76%) were symptomatic in the following proportion: leg heaviness, 236 (64.48%); sensation of swelling, 236 (64.48%); pain, 194 (53%); sensation of "pins and needles," 87 (23.77%); night cramps, 89 (24.39%); and itching, 66 (18.03%). Men had more symptoms (P = .027). The mean total VCSS was 4.62 ± 4.15 (range, 1-21). The most frequent VCSSs were 0, 2, 3, and 4, and the components of the VCSS most frequently represented were pain, varicose veins, and edema.Patients were assigned to CEAP classes as follows. The C class included C0, 6.1%; C1, 35.4%; C2, 39.6%; C3, 42.7%; C4a, 11.9%; C4b, 4.9%; C5, 1.5%; and C6, 10.13%. The E class designated etiology as primary in 446 (88.66%), secondary in 49 (9.7%), and congenital in 8 (1.59%). The A class identified superficial veins in 365 (72.56%), deep veins in 218 (43.33%), and perforator veins in 22 (4.37%); no venous location was identified in 31 (6.16%). According to the P classification, of the 466 legs of level II and III CEAP, 289 (62%) had reflux, 43 (9.2%) had obstruction, 22 (4.6%) had both reflux and obstruction, and 113 (24.3%) had no venous disease identifiable, with no sex influence on the frequency of reflux (P = .27) but a higher proportion of obstruction in men (P = .00029). CONCLUSIONS: Patients have many risk factors and are young with a male predominance. Most patients are symptomatic with advanced disease. The etiology is primary in most patients, and reflux is more common.

Comparison of hysterosalpingograms with laparoscopy in the diagnostic of tubal factor of female infertility at the Yaoundé General Hospital, Cameroon.

INTRODUCTION: The objectives were to assess the diagnostic value of hysterosalpingography (HSG) with laparoscopy as gold standard in the evaluation of tubal patency and pelvic adhesions in women suffering from infertility. METHODS: We conducted a comparative cross sectional study on 208 medical files of infertile women followed up at the Yaoundé General Hospital during a period of five years (December 2007 to December 2012). Tubal patency, hydrosalpinx and pelvic adhesions detected at HSG were compared with laparoscopic findings as the gold standard. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of HSG were calculated with 95% confidence interval (CI). RESULTS: Mean age of the patients was 31.4 ± 6.45 years. Secondary infertility was the most frequent type of infertility (66.82%). HSG had a moderate sensitivity (51.0%; 95% IC. 37.5-64.4), high specificity (90.0%; 95% IC.74.4-96.5), high PPV (89.3%; 95% IC. 72.8-96.3) and a moderate NPV (52.9%; 95% IC. 39.5-65.9) in the diagnosis of bilateral proximal tubal occlusion. Concerning, distal tubal patency, HSG had a high sensitivity (86.8%; 95% IC. 76.7-92.9), low specificity (42.2%; 95% CI. 29.0-56.7), moderate PPV (69.4%; 95% IC. 58.9-78.2) and a moderate NPV (67.9%; 95% IC. 49.3-82.0) in the diagnosis of bilateral or unilateral distal tubal occlusion. However, HSG had a low diagnostic value (27.8%; 95%IC.18.8-39.0) in the pelvic adhesions. CONCLUSION: HSG is of limited diagnostic value in tubal factor infertility and is of low diagnostic value for pelvic adhesions.

Connaissances; attitudes et pratiques des professionnels de la sante sur le cancer du sein a l'hopital general de Yaounde; Cameroun

OBJECTIFS. Cette etude avait pour objectif d'evaluer les connaissances; attitude et pratique des professionnels de la sante de l'Hopital General de Yaounde sur le depistage du cancer du sein. MeTHODES. Il s'agissait d'une etude transversale descriptive qui s'est deroulee a l'Hopital General de Yaounde (HGY) du 5 fevrier au 5 juin 2014. Les donnees sur les connaissances; attitude et pratique des professionnels de sante sur le depistage du cancer du sein etaient collectees par un questionnaire. ReSULTATS. Des 330 personnes interrogees; 306 ont accepte de participer a l'etude soit un taux de reponse du personnel de sante de 92%.Tout le personnel de sante (100%) de l'HGY avait deja entendu parler du cancer du sein. La quasi-totalite (93;5%) de ce personnel a reconnu l'existence de facteurs de risques de cancer du sein. La mammographie et l'auto examen des seins (AES) sont citees comme moyens de depistage respectivement par 94;1% et 86;6% des participants. Parmi les 195 professionnels de la sante feminins de l'HGY; 157 (80;7%) pratiquaient un depistage du cancer du sein a titre personnel. Moins du quart (23;5%) de ce personnel pratiquaient regulierement l'AES tous les mois. La mammographie de depistage n'etait pratiquee que par 22;5% de ce personnel feminin ages de 45ans et plus. CONCLUSION. Le personnel de sante de l'HGY a un bon niveau de connaissance du depistage du cancer du sein. Cependant; son taux de pratique d'un depistage personnel du cancer du sein par la mammographie ou l'AES mensuelle est faible

Acute pulmonary embolism in the era of multi-detector CT: a reality in sub-Saharan Africa.

BACKGROUND: The advantages of multi-detector computed tomography (MDCT) have made it the imaging modality of choice for some patients with suspected cardiothoracic disease, of which pulmonary embolism (PE) is an exponent. The aim of this study was to assess the incidence of PE in patients with clinical suspicion of acute PE using MDCT in a sub-Saharan setting, and to describe the demographic characteristics of these patients. METHODS: Consecutive records of patients who underwent MDCT pulmonary angiography for suspected acute PE over a two-year period at the Radiology Department of a university-affiliated hospital were systematically reviewed. All MDCT pulmonary angiograms were performed with a 16-detector computed tomography (CT) scanner using real-time bolus tracking technique. Authorization for the study was obtained from the institutional authorities. RESULTS: Forty-one MDCT pulmonary angiograms were reviewed of which 37 were retained. Of the 4 excluded studies, 3 were repeat angiograms and 1 study was not technically adequate. Twelve of 37 patients (32.4%) had CT angiograms that were positive for PE, of which 7 were males. The mean age of these patients was 47.6±10.5 years (age range from 33 to 65 years). Twenty five patients out of 37 (67.6%) had CT angiograms that were negative for PE. Eleven PE-positive patients (91.7%) had at least 1 identifiable thromboembolic risk factor whilst 5 PE-negative patients (20%) also had at least a thromboembolic risk factor. The relative risk of the occurrence of PE in patients with at least a thromboembolic risk factor was estimated at 14.4. CONCLUSION: Acute PE is a reality in sub-Saharan Africa, with an increased likelihood of MDCT evidence in patients with clinical suspicion of PE who have at least a thromboembolic risk factor. The increasing availability of MDCT will help provide more information on the occurrence of PE in these settings.

Surgical repair of a giant isolated inflammatory aneurysm of the left common iliac artery.

Isolated aneurysms of the iliac artery (IA) are very rare. Inflammatory aneurysms are also rare conditions, making the association rarer. Only four cases of isolated inflammatory IA aneurysms have been reported in the last decade. In this article, we report a case of a 62-year-old patient with a 13-cm large isolated inflammatory aneurysm of the left common IA associated with a 2.5-cm right common IA involvement. The patient presented with a left lower quadrant pain, a pulsatile mass with bruit, as well as a left hydronephrosis secondary to the ipsilateral ureter entrapment, and a motor and sensory deficit of the left lower extremity. An aortoiliofemoral prosthetic repair associated to a left to right ureteral transposition was undertaken with an approach including a laparotomy and bilateral femoral artery exposure. The postoperative period was uneventful. The case mentioned in this study is probably the largest IA aneurysm ever described.

Surgical repair of a giant pseudoaneurysm of the right common carotid artery following a gunshot.

Common carotid pseudoaneurysms are very rare. The authors report a case of a 18-year-old patient with 11 cm large posttraumatic pseudoaneurysm of the right common carotid artery caused by a gunshot in the neck. The patient also had a right hemiplegia, secondary to the left sylvian artery stroke and aphasia. A surgical repair was undertaken with an approach including a total sternotomy. The aneurysm was excluded and a saphenous vein patch was used to repair the 2-cm defect on the arterial wall. The postoperative period was uneventful. This is probably the largest carotid artery aneurysm ever described. The potential hazards of an aneurysm of the common carotid artery indicate that surgical treatment is warranted particularly in a patient with a past history of controlateral stroke.