[Giant aneurysm of the pulmonary artery: a case report]. / Anévrisme géant de l'artère pulmonaire: à propos d'un cas.

Pulmonary artery aneurysm is a rare condition accounting for less than 1% of all intra thoracic aneurysms. This paper reports a case of giant aneurysm of the trunk and branches of the pulmonary artery, which was discovered incidentally on a computed tomography angiogram in a 48-year-old man with a past history of pulmonary tuberculosis. Besides the aneurysm there was dilation of the pulmonary annulus with massive pulmonary regurgitation, a tight mitral stenosis and sequelae of pleural and pulmonary tuberculosis. The patient is being followed-up with medical treatment and has been stable clinically for the last ten months.

[Prolactinomas in Yaounde: analytical study of 36 consecutive cases followed in the internal medicine department of the Yaounde Hospital from 1990 to 1996]. / Les adénomes à prolactine à Yaoundé: étude analytique de 36 cas consécutifs suivis dans le service de médecine interne de l'Hôpital de Yaoundé de 1990 à 1996.

We analysed the epidemiological, clinical, biological, morphological and therapeutic characteristics of 36 cases of pituitary prolactinomas in Yaoundé, Cameroun. Diagnosis was made on the basis of neuro-ophthalmological, gynaecological and sexual symptoms associated with quantity determinations of prolactinemia, total testosterone and blood oestrogen, folliculo stimulating hormone and luteining hormone. Expected levels of prolactinemia are above 150 micrograms/l. Cerebral tomodensitometry and, where possible, magnetic resonance imaging were used. Among the 24 patients on whom a tomodensitometry was performed, 4 male patients presented macroprolactinomas; the remaining 20 patients--mostly female--had microprolactinomas. Macroprolactinomas were found in male patients only, leading to an acute ophthalmological emergency for 2 of them who were operated in Paris-France. All the patients were put on bromocriptine; this molecule has antisecretory and antiproliferative properties, which are very useful in Africa, since surgery is very expensive. Cases of resistance to the molecule exist and new dopaminergic agonists are not yet being used in Cameroon.

[Severe forms of malaria in children in a general hospital pediatric department in Yaounde, Cameroon]. / Les formes graves du paludisme de l'enfant dans un service de pédiatrie générale à Yaoundé, Cameroun.

Severe forms of malaria in children are responsible for 1 million deaths yearly in young children in hyperendemic areas. The main objective of this study was to identify and compare common manifestations of different forms of severe malaria and to evaluate the prognosis for hospital treatment in an endemic area. 271 files of children admitted into hospital between March 1991 and September 1996 were analysed. These children were confirmed to have Plasmodium falciparum in their peripheral blood. 78 patients (29%) had the severe form of malaria. 43 patients (53%) were under 5 years of age. The 5 severe types identified were characterized by very high temperatures 28 cases (36%), cerebral malaria 20 cases (26%), prostration and weakness 15 cases (19%), severe anaemia 14 cases (18%) and haemoglobinuria 1 case (1.3%). Cerebral malaria and severe anaemia were more common in children under 5 years old. The average parasitemia was 16,366 +/- 1390 parasites per microlitre. Clearance of parasitemia was obtained on day 3 in almost all cases; 6 patients with very high temperatures presented neither sign of visceral complications nor convulsions. The average period in coma for cases of cerebral malaria was 1.7 days; 12 anaemic patients were transfused. There were no deaths. No abnormality was found on physical examination after an average hospitalisation of 5.3 days. An early diagnosis and adequate treatment of severe forms of malaria in children by qualified personnel will usually result in a favourable prognosis in our area.

[The value of medical imaging in the diagnosis and assessment of local and regional extension of cancers of the cavum at Yaounde]. / Apport de l'imagerie médicale dans le diagnostic et le bilan d'extension loco-régionale des cancers du cavum à Yaoundé.

In this work, we aimed to provide a clear description of the contribution to and role of major imaging techniques in the diagnosis of cancers of the cavum and assessment of their local and regional expansion. This should provide doctors with a useful guide for decisions concerning the imaging technique to be used. This is a retrospective analysis of 41 cases of cavum cancer, all confirmed by histology. The series consisted of 29 male patients (70%) and 12 female patients (30%), giving a sex ratio of 2.4. The mean age of the patients was 42 years (range: 11 to 71 years). All patients were examined and treated in the Radiology and Oncological Radiotherapy Department of Yaounde General Hospital over a period of eight years (December 1988 to November 1996 inclusive). All data relating to diagnosis, assessment of local and regional expansion and the response of the tumor to treatment were retrieved from the medical files and analyzed. We found that clinical diagnosis of cancer of the cavum was difficult and this cancer was often diagnosed late. It was therefore often necessary to resort to paraclinical means of diagnosis and assessment of expansion, such as endoscopy, conventional X rays and tomography. Endoscopy and conventional X rays give poor results but may be used if there is a lack of equipment or for an initial examination, to be followed by assessment using other methods. Tomography remains the most effective technique and is recommended for the diagnosis of cancers of the cavum and for assessment of their local and regional expansion.

[Therapeutic management of primary digestive lymphomas at Yaoundé: analysis of a series of 46 cases]. / Prise en charge thérapeutique des lymphomes digestifs primitifs à Yaoundé: analyse d'une série de 46 cas.

The aim of this study was to identify the principal deficiencies and difficulties associated with the treatment of primary digestive lymphomas at Yaounde. We analyzed the medical records of 46 patients treated at Yaounde General Hospital over a period of 7 years (January 1989 to December 1996). The study population consisted of 24 men (52%) and 22 women (48%), giving a sex ratio of 1.08. The mean age of the patients was 49 years (range: 18 to 80 years). The treatment of these patients was not always optimal, due largely to socioeconomic and technical factors. We observed cases of very late diagnosis in which the histological data were imprecise or incomplete, in the absence of modern histological techniques. Assessment of the expansion of tumors was frequently inadequate, due to the absence of scanners or the inability to pay for their use. These problems, and the high cost of chemotherapy and radiotherapy, have severely limited the efficacy of treatment, resulting in poorer responses to treatment than reported elsewhere. In conclusion, national solidarity and cooperation at the regional and international levels seem to be necessary in these clinical conditions, to overcome these obstacles and to improve the quality of treatment for patients in general, and for those with primary digestive lymphomas in particular.

Superior vena cava tumoral thrombosis revealing a Burkitt's lymphoma and a lymphoblastic non-Hodgkin's lymphoma. A case report.

Superior vena cava thrombosis (SVCT) is a rare pathology, though of great significance since it implies the development of a malignant process. The most common etiologies are basically bronchopulmonary and mediastinal tumors. Observations involving 2 patients presenting with superior vena cava syndrome (SVCS) are reported in this study, in which radiologic investigations (chest roentgenogram, computed tomography scan of the thorax, and superior vena cavography) revealed thrombosis of the SVC disclosing in both cases a non-Hodgkin's lymphoma. The first case was a mediastinal Burkitt's lymphoma in a thirty-eight-year-old man (exceptional form) and in the second case a lymphoblastic non-Hodgkin's lymphoma in a nine-year-old girl. In the patient with Burkitt's lymphoma healing was satisfactory twenty-four months after treatment by surgery, chemotherapy, and radiotherapy. The second patient died suddenly. In both cases the SVCT revealed the tumor. The causes of SVCT are reviewed and discussed.

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.

[Developing cancer from a probable misdiagnosed pancreatic cystadenoma]. / Cancérisation d'un probable cystadénome pancréatique méconnu.

This paper reports the malignant transformation of a benign pancreatic cyst treated by internal drainage in a 30-year-old woman. The initial lesion was diagnosed on surgical biopsy of the cyst wall. The diagnosis of pancreatic carcinoma was made after one year of satisfactory course, by fine needle cytologic aspiration of the fibrous retraction of the cyst; at that time the patient had severe pancreatic pain with multinodular liver on ultrasonography. The conclusion is the recommendation of total excision of pancreatic cysts whenever the diagnosis is incomplete or imprecise.

Aspect radiologique de la tuberculose de hanche : a propos d'un cas tardivement diagnostique

Les auteurs rapportent un cas didactique de tuberculose isolee de la hanche tardivement diagnostique chez un adulte jeune de 34 ans; explore et traite a l'Hopital General de Yaounde. La tomodensitometrie a ete suggestive et a permis de faire le bilan complet des lesions articulaires et peri-articulaires. Le traitement d'epreuve anti-tuberculeux a confirme a posteriori le diagnostic. Les auteurs soulignent l'interet de scanner dans le diagnostic lesionnel; le bilan topographique et la surveillance post-therapeutique de la coxalgie

[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.

Maladie ulcereuse gastro-duodenale : acces aux moyens de diagnostic et de traitement en milieu tropical

Une etude prospective portant sur l'analyse des antecedents de 72 malades operes au CHU de Yaounde d'un ulcere gastro-duodenal complique avait pour but d'evaluer l'acces des malades aux moyens de diagnostic et de traitement pendant la maladie ulcereuse et pendant les complications. Les stenoses etaient la complication chirugicale la plus frequente (69;4 pour cent) devant les hemorragies (16;6 pour cent) et les perforations chez 43 malades (59;7 pour cent). Les examens diagnostiques avaient ete demandes chez 25 malades (34;7 pour cent); dont 9 TOGD et 6 fibroscopies; chez les 15 malades ayant eu une complication sur un ulcere connu; 5 malades (33;3 pour cent) avaient pu suivre dans le passe un traitement medical correct. Avec la survenue des complications; tous les malades ont eu acces aux moyens de diagnostic; dont 50 TOGD et 6 fibroscopies pour le diagnostic des hemorragies et et 8 radiographies de l'abdomen sans preparation pour le diagnostic des perforations. Apres le traitement chirurgical 6 malades (8;5 pour cent) ont poursuivi un traitement medical correct pendant 45 jours. En conclusion; cette etude montre que peu de malades souffrant de maladie ulcereuse gastro-duodenale ont acces aux moyens modernes de diagnostic et de traitement en milieu tropical. Une meilleure politique sanitaire s'impose en vue de controler cette maladie avant la survenue des complications

[Diagnostic problems apropos of 2 clinical cases of lumbar Pott's disease]. / Problèmes diagnostiques à propos de deux cas cliniques de mal de POTT lombaire.

Two cases of POTT's disease without radiological osteoarticular destructions have been diagnosed from a psoas and a dorsal abscess. Bacteriology and histology were negative at the beginning, then became positive after a long evolution of the wound. The recommendation is to think of POTT's disease when confronted with any paravertebral abscess, with or without radiological signs and to repeat the bacteriological and histological tests if necessary.

[Solitary extra-osseous ovarian plasmacytoma. Apropos of an unusual case in a 12 year old child]. / Le plasmocytome solitaire extraosseux ovarien. A propos d'un cas exceptionnel chez une enfant de 12 ans.

A rare case of extramedullary or solitary ovarian plasmocytoma in a 12 years old patient is reported. Surgery consisted of left adnexectomy associated with omentectomy. Chemotherapy with abdomino-pelvic iradiation were effectuated afterwards. Review of literature and therapeutic indications are discussed.

[Chronic pancreatitis in Cameroon. Analysis of etiological and clinical aspects]. / Pancréatites chroniques au Cameroun. Analyse des aspects étiologiques et cliniques.

In a collection of 3,571 patient's files admitted in the University Teaching Hospital and the Yaounde General Hospital, we studied 27 patients suspected of chronic pancreatitis. 20 patients with calcified chronic pancreatitis benefited from a detailed history, physical examination and a complete paraclinical work-up. From the data collected, chronic alcoholism seemed to have been the main aetiology. Industrial beer from barley alone and/or associated with other traditional liquors was most consumed. The majority of patients were heavy alcoholics and daily consumption varied from 75 to 124 g of pure alcohol. The natural history of the disease and physical examination were identical to that observed in the western countries. Associated pathology was observed in 10% of the patients. This included peptic ulcer disease, cirrhosis and bile stones. Complications included diabetics, obstructive jaundice, and malabsorption syndrome. As a conclusion, chronic pancreatitis is a pathology whose prevalence seems to be progressing constantly.

Extraintestinal amebiasis.

Extraintestinal involvement is a dreaded complication of amebiasis, with a reported mortality rate of 7%-14%. The authors retrospectively studied 188 patients with extraintestinal amebiasis confirmed by means of clinical, surgical, and radiologic criteria over a 45-month period. Ultrasonography (US) was the mainstay of radiologic investigation. Liver abscess was present in 183 patients (97%); five patients (3%) had other organ involvement but a normal liver. The majority of liver abscesses were in the right lobe. US is recommended for the diagnosis and follow-up of patients with extraintestinal amebiasis. It is noninvasive, simple, easily reproducible, and less expensive than computed tomography. Portable models can be taken into remote areas of the less-developed world.

[Obstructive jaundice in Yaounde. Value of echography and transhepatic cholangiography in determining the cause]. / Ictères obstructifs à Yaoundé. Valeur de l'échographie et de la cholangiographie transhépatique dans la recherche de la cause.

The purpose of the study was to assess the clinical value of ultrasonography (US) and percutaneous transhepatic cholangiography (PTC) in the workup of obstructive jaundice in Yaoundé. From 3,000 ultrasonographic studies done between September 1987 and February 1990, the authors drew 37 cases of obstructive jaundice. 22 of them were explored with both US and PTC. The cause of obstruction was tumor for 14, inflammation or malformation for 4 and biliary stone for 4. US could predict the cause in 55 p. cent of cases and PTC in 77 p. cent of cases. PTC was particularly helpful in case of non tumoral causes. The authors conclude that, in their setting where computed tomography is scarce and expensive, the combination of both US and PTC is rewarding, when the problem is the determination of the nature of obstruction.

Gall stone disease in African patients with sickle cell anaemia: a preliminary report from Yaounde, Cameroon.

Cholecystosonography was undertaken in 90 patients with sickle cell disease aged 15 years and over. Gall stones were found in 26 (28.9%) patients. There was no sex difference, but the incidence increased with age from 13.2% at under 20 years to 75% at 30 years and over. The mean serum cholesterol and total and unconjugated bilirubin concentrations were not significantly different between patients with and without gall stones. As most (80.8%) stones were radiolucent they were probably of pigment type, containing little or no calcium, and further investigation into how they are produced is needed. Sickle cell patients with acute abdominal crisis should have gall bladder disease excluded before a diagnosis of vascular crisis is made.