Traitement des cancers associes au VIH/SIDA: notre experience de 25 ans a l'hopital general de Yaounde

OBJECTIF. evaluer retrospectivement les protocoles et modalites de traitement des cancers associes au VIH/SIDA a l'Hopital general de Yaounde en vue de redefinir une approche therapeutique plus adaptee et efficace. MATeRIELS ET MeTHODES. Il s'agit d'une etude retrospective et analytique de 824 dossiers de patients avec une serologie VIH positive; sous antiretroviraux et traites ces 25 dernieres annees (1989-2014) dans le service de radiotherapie de l'Hopital general de Yaounde pour tumeurs malignes viro-induites histologiquement confirmees. ReSULTATS. 138 Patients (16;75%) du groupe pronostic intermediaire; n'ont ete traites que dans un second temps par radiotherapie exclusive apres amelioration de leur etat general grace aux ARV et autres soins medicaux. Leur taux de survie a 5 ans et 10 ans a ete de 20 et 10% respectivement. 248 patients (30;1%) du bon groupe pronostique; ont d'emblee beneficie d'une radiotherapie a but curatif; avec un taux de survie; a 5ans et 10ans; de 70% et 65% dans cet ordre. Enfin 438 patients (51;15%) du groupe mauvais pronostique avec cancers aux stades tres avances T4N+M+; et tres mauvais etat general ont recus un traitement palliatif avec un taux de survie a 5 ans et 10 ans; de 10% et 5% dans cet ordre. CONCLUSION. Une approche therapeutique privilegiant la concertation multidisciplinaire demeure porteuse d'espoir avec l'avenement des ARV et la disponibilite des soins medicaux d'appui susceptibles meme pour les cas de mauvais pronostic; de booster l'etat general des malades et l'action de la radiotherapie; associee ou non a la chirurgie et/ou a la chimiotherapie. Ainsi ne devons-nous pas baisser les bras encore plus discriminer!

Traitement des cancers associes au VIH/Sida : notre experience de 25 ans a l'hopital general de Yaounde

OBJECTIF. evaluer retrospectivement les protocoles et modalites de traitement des cancers associes au VIH/SIDA a l'Hopital general de Yaounde en vue de redefinir une approche therapeutique plus adaptee et efficace. MATeRIELS ET MeTHODES. Il s'agit d'une etude retrospective et analytique de 824 dossiers de patients avec une serologie VIH positive; sous antiretroviraux et traites ces 25 dernieres annees (1989-2014) dans le service de radiotherapie de l'Hopital general de Yaounde pour tumeurs malignes viro-induites histologiquement confirmees. ReSULTATS. 138 Patients (16;75%) du groupe pronostic intermediaire; n'ont ete traites que dans un second temps par radiotherapie exclusive apres amelioration de leur etat general grace aux ARV et autres soins medicaux. Leur taux de survie a 5 ans et 10 ans a ete de 20 et 10% respectivement. 248 patients (30;1%) du bon groupe pronostique; ont d'emblee beneficie d'une radiotherapie a but curatif; avec un taux de survie; a 5ans et 10ans; de 70% et 65% dans cet ordre. Enfin 438 patients (51;15%) du groupe mauvais pronostique avec cancers aux stades tres avances T4N+M+; et tres mauvais etat general ont recus un traitement palliatif avec un taux de survie a 5 ans et 10 ans; de 10% et 5% dans cet ordre. CONCLUSION. Une approche therapeutique privilegiant la concertation multidisciplinaire demeure porteuse d'espoir avec l'avenement des ARV et la disponibilite des soins medicaux d'appui susceptibles meme pour les cas de mauvais pronostic; de booster l'etat general des malades et l'action de la radiotherapie; associee ou non a la chirurgie et/ou a la chimiotherapie. Ainsi ne devons-nous pas baisser les bras encore plus discriminer!

Giant pseudoaneurysm of the left axillary artery following a stab wound.

Axillary artery pseudoaneurysms are rare. We report on a 30-year-old patient with a 6.5-cm post-traumatic pseudoaneurysm of the left axillary artery two months after a knife stab wound of the shoulder. The patient showed axillary fullness and signs of severe brachial plexus compression. A surgical repair was undertaken. The aneurysm was excluded and a saphenous vein interposition was performed. The early and late postoperative periods were uneventful. This is probably not only the largest axillary artery pseudoaneurysm ever reported, but also the first secondary to a stab wound.

[Cardiac surgery in Cameroon. Results at one year of the pilot phase]. / Chirurgie cardiaque au Cameroun. Résultats à un an de la phase pilote.

In the framework of implementation of his national program for control and prevention of cardiovascular diseases, Cameroonian government has set up a cardiac surgery project. We report in this manuscript results of one year follow up of the patients operated during the pilot phase. From September 22 till 26, 2008, 11 patients have been operated in Cameroun. Surgical procedures were 5 mitral mechanic valve replacement, 2 aortic mechanic valve replacement, 1 atrial septal defect closure, 2 pace maker implantation. No intrahospital death was observed. One patient died at 11th month after the operation due to mitral valve thrombosis and attributed to lack of compliance. One patient presented low cardiac output, pneumonia and a pleural effusion. 2 patients presented 2 minor complications consisting of pericarditis and superficial wound infection. The results of the pilot phase of cardiac surgery in Cameroon are effective. However, the sustainability of the program require human, material capacity building, and funding mechanism as well.

[Analysis of operative indications and outcomes in 238 re-operations after abdominal surgery in an economically disadvantaged setting]. / Réinterventions de chirurgie abdominale en milieu défavorisé : indications et suites opératoires (238 cas).

AIM OF THE STUDY: We analyse aspects of re-operative abdominal surgery in an economically disadvantaged environment with respect to indications, operative findings, treatment modalities, and outcomes. PATIENTS AND METHODS: Retrospective chart review over a seven-year period of patients requiring re-operative surgery during the same hospitalization or within 30 days of initial surgery. RESULTS: During the study period, 7714 laparotomies were performed. Two hundred and seventy-seven (3.6%) required re-operation; of these, 238 charts (86%) were able to be reviewed. The decision for operative re-intervention was made mainly on the basis of clinical findings. Postoperative peritonitis (50.8%), adhesive bowel obstruction (23.9%), and intestinal fistula (10.9%) were the main indications for re-intervention. Complications occurred in 35% and included postoperative infection (n=70, 33%) and abdominal wall dehiscence (n=37, 15.5%). Mortality was 18% and increased significantly when the initial operative procedure was for peritonitis and re-operation was due to septic complications. CONCLUSION: In an economically disadvantaged environment, the re-operation rate after an abdominal surgery does not seem to be higher than that seen in series from developed countries, although there may be factors which bias this observation. The mortality rate for cases with postoperative peritonitis is high, but operative re-intervention based on clinical findings is still considered the favored strategy in our environment. Results may improve with better material medical conditions.

[Treatment of early T1 small T2N breast cancers. Our experience at the Yaounde General Hospital. 21 cases]. / Traitement des cancers du sein aux stades précoces T1 petit T2 N-notre experience a l'Hôpital Général de Yaoundé. A propose de 21 cas.

From February 1989 through February 1993, a group of 23 patients suffering from T1 mammary carcinoma small T2 N-MO was treated in the radiotherapy department of the Yaoundé General Hospital, according to a simplified procedure. A first conservative surgery of tumorectomy type (3 cases) and quandrantectomy type (4 cases) was carried out, followed by a postoperative irradiation. In 14 cases, a Patey type radical surgery preceded a local/regional radiotherapy. The general treatment was made up of only a hormonotherapy without chemotherapy. After a 4-year decline, there were 5 cases--i.e. 23.8%--of ganglionic and/or metastatic relapse. In the light of research data, we are analysing the reasons for these unexpected therapeutic failures in this group of tumor considered as favorable prognosis. We raised the problem of the inability of the prognosis factors, presently defined by means of histological and biological factors, to detect all the especially aggressive cancers. We carried out a general review of the new factors defined essentially from molecular and genic bases. We offered an approximative solution which makes it possible to by-pass the technological difficulties in having access to the new factors.

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.

[Abscess of the rectovaginal wall in women. Apropos of a case]. / Abcès de la cloison recto-vaginale chez la femme. A propos d'un cas.

Recto-vaginal septum abscess is a rare entity in women. The authors report a rare clinical observation of a recto-vaginal septum abscess in a 40 year old woman, hospitalized and treated in the Surgical Unit of the Yaounde General Hospital. Medical literature was reviewed and surgical indications discussed.

[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.

[Postoperative necrotizing fasciitis in infants. Apropos of a case]. / Fasciite nécrosante post-opératoire chez le nourrisson. A propos d'un cas.

A case of postoperative necrotizing fasciitis after a right incarcerated inguinal hernia repair is reported in a six week old baby hospitalized in the paediatric surgical unit of the Yaounde General Hospital. Treatment consisted in a medical reanimation, surgical debridement and an appropriate antibiotherapy. Medical literature was reviewed and therapeutic indications discussed.

Difficultes et interets d'une exploitation optimale du role et de la signification des ganglions regionaux dans les cancers au Cameroun. [Mise au point]

Une etude de fiabilite de 209 dossiers medicaux adresses aux consultations de cancerologie radiotherapie a ete menee. Une enumeration de toutes les informations d'origine ganglionnaire regionale qui contribuent a la connaissance du statut tumoral; des facteurs de pronostic du bilan d'extension et de la classification de la maladie maligne avait pour but final d'operer le meilleur choix de la strategie therapeutique. Un rappel didactique de la signification des principaux parametres a ete realise. Un accent particulier a ete mis sur la necessite d'une bonne documentation des dossiers apres que les raisons de leur mauvaise tenue aient ete relevees

[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.

[Benign giant epignathic teratoma in the newborn. Apropos of an unusual clinical case]. / Tératome épignathe géant bénin chez le nouveau-né. A propos d'une observation clinique exceptionnelle.

A rare case of giant epignathus teratoma with intracranial extension is reported in a male newborn. Pre-operative diagnosis of teratoma was made or suspected on radiological evidence of calcification within the tumor and increased level of alpha-foetoprotein. Optimal treatment consisted in complete surgical resection. The literature is revisited and surgical indications are discussed.

[Value of pedicled myoplasty in the treatment of severe mediastinitis. A case report]. / Intérêt de la myoplastie pediculée dans le traitement des médiastinites graves. A propos d'un cas.

Sternotomy is the approach of choice for cardiac surgery. Mediastinitis is a rare complication of median sternotomy with high morbidity and mortality. We describe a case of severe mediastinitis occurring after median sternotomy performed in a patient presenting diving goiter. Two-stage irrigation/drainage was unsuccessful. This failure led to opening of the chest and coverage with a pediculated flap using the grand pectoralis muscle. This stratagem allowed complete healing. This case provides an opportunity to discuss the different surgical techniques used to treat severe mediastinitis and to emphasize the value of muscle flaps in the management of recalcitrant median sternotomy wounds.

L'experience camerounaise en chirurgie cardiaque: a propos de 83 cas operes de 1985 a 1990

La chirurgie cardiaque a ete introduite au Cameroun en 1985 au CHU de Yaounde. Six missions de chirurgie cardiaque ont ete effectuees au Cameroun de juillet 1985 a avril 1990. Nous nous sommes proposes d'evaluer cette experience initiale dans notre pays et d'essayer d'etablir la courbe de survie des patients operes cardiaques. L'etude a ete essentiellement menee au CHU de Yaounde. Au total; 83 sujets dont 42 femmes et 41 hommes ont ete operes. Leur age varie de 9 a 60 ans avec une moyenne de 29 ans. Parmi ces malades 53 pour cent des sujets etaient au stade fonctionnel III et IV de la NYHA en preoperatoire et 95;3 pour cent presentaient une insuffisance cardiaque refractaire au traitement medical. Les remplacements valvulaires sur valvulopathies post-rhumatismales representaient la principale indication (77 cas). 4 cardiopathies congenitales (1 communication interauriculaire; 1 communication interventriculaire et 2 canaux arteriels persistants); 5 pericardites (2 constrictives; 1 serofibrineuse et 1 purulente) et 1 endomyocardite fibreuse ont egalement ete repertoriees. Les resultats ont ete remarquables; car ils ont permis a une grande majorite d'operes une survie d'au moins 5 ans. Cependant; le cout de la chirurgie cardiaque reste toujours eleve quoique de loin preferable a celui d'une evacuation sanitaire a l'etranger

L'experience camerounaise en chirurgie cardiaque: a propos de 83 cas operes de 1985 a 1990

La chirurgie cardiaque a ete introduite au Cameroun en 1985 au CHU de Yaounde; sous l'egide du Ministere de la Sante Publique et grace a l'impulsion de quelques pionniers camerounais; avec la collaboration des equipes chirugicales francaises de Lyon et de Marseille. Nous nous sommes proposes d'evaluer cette experience initiale dans notre pays et d'essayer d'etablir la courbe de survie des patients operes cardiaques. Au total; 83 sujets ont ete operes. leur age varie de 9 a 60 ans avec une moyenne de 29 ans. Parmi ces malades 53 pour cent des sujets etaient au stade fonctionnel III et IV de la NYHA en preoperatoire et 95;3 pour cent presentaient une insuffisance refractaire au traitement medical. [abstract terminated]

[Treatment of a neglected traumatic perforation of the cervical esophagus by a muscular flap from the sterno-cleido-mastoid muscle. Apropos of a case]. / Traitement d'une perforation traumatique négligée de l'oesophage cervical par plastie musculaire du sterno-cléidomastoïdien. A propos d'un cas.

The diagnosis and management of oesophageal perforation is quite a problem. When the perforation is diagnosed early, treatment is easy with subsequently good results. When the diagnosis is delayed, treatment become complex, with a morbidity rate of about 35% and a high morbidity. This simple case report, describe the use of a sternocleido-mastoid muscle flap in the repair of a traumatic cervical oesophageal perforation with important loss of substance.

[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.

[Pyloric obstruction. Apropos of a new clinical case with this rare pathology]. / Le diaphragme pylorique. A propos d'une nouvelle observation clinique de cette pathologie rare.

The authors describe a pyloric obstruction due to a mucosal diaphragm in a 16 months old child. They review the literature, and emphasize on the rare frequency on this affection, the steps of its diagnosis, and its surgical removal.