ABSTRACT
Cervix cancer remains a public health problem in developing countries. These results are an assessment for multicentric study based on visual inspection of the cervix after application of acetiq acid (VIA) and lugol's iodine (VILI). The aim of this study is to determine the feasibility and the impact of this screening in the community health centres "CSCOM" in the district of Bamako. It was a prospective and multicentric study through 8 CSCOM, 3 Reference Centres "CSRéf", Hôpital Gabriel Touré (HGT) and National Institute of Public Health (INRSP) in Bamako. During 28 months, 5016 women aged through 25-49 years were screened. After their consent and questionnaire filling, the patient is comfortably settled for visual test. The repartition of screened patients by health level is: CSCOM (19.24% : 965/5016), CSRéf (48.64% : 2440/5016), HGT (32.12% : 1611/5016). In general, the positivity of tests was: 5.2% (VIA) and 6.8% (VILI). The positive women at the CSCOM level were oriented to the CSRéf or the HGT for the colposcopy, possible biopsy or care. At all 177 biopsies were done, and histological diagnosis were: 67 dysplasias, 3 early invasive carcinomas, 69 invasive carcinomas and 38 inflammatory metaplasic lesions or nonconclusives aspects. Patients with dysplasias or cancers were treated by cryotherapy, loop electrosurgical excision procedure (LEEP), cold-knife conization or surgery. This study showed that screening of cervical cancer by visual inspection is workable at CSCOM level. We wish a large diffusion of the method to the whole of the country.
Subject(s)
Adenocarcinoma/diagnosis , Carcinoma, Squamous Cell/diagnosis , Community Health Centers/organization & administration , Mass Screening/organization & administration , Uterine Cervical Neoplasms/diagnosis , Acetic Acid , Adenocarcinoma/epidemiology , Adenocarcinoma/prevention & control , Adult , Biopsy , Carcinoma, Squamous Cell/epidemiology , Carcinoma, Squamous Cell/prevention & control , Coloring Agents , Community Health Centers/statistics & numerical data , Female , Health Services Accessibility , Hospitals, University/organization & administration , Hospitals, University/statistics & numerical data , Humans , Iodides , Mali/epidemiology , Mass Screening/methods , Mass Screening/statistics & numerical data , Metaplasia , Middle Aged , Physical Examination , Prospective Studies , Staining and Labeling , Uterine Cervical Dysplasia/diagnosis , Uterine Cervical Dysplasia/epidemiology , Uterine Cervical Dysplasia/prevention & control , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/prevention & control , Uterine Cervicitis/diagnosis , Uterine Cervicitis/epidemiologyABSTRACT
Le cancer du col de l'uterus demeure un probleme de sante publique dans les pays en developpement. Le present travail constitue un bilan d'une etude multicentrique basee sur l'inspection visuelle du col apres application d'acide acetique (IVA) et de lugol (IVL). L'objectif assigne a ce travail est de determiner la faisabilite et l'impact de ce depistage au niveau des centres de sante communautaires du district de Bamako. Il s'agissait d'une etude prospective multicentrique a travers 8 CSCOM; 3 Centres de Sante de Reference (CSRef); l'Hopital Gabriel Toure (HGT) et l'Institut National de Recherche en Sante Publique (INRSP) de Bamako. Sur une periode de 28 mois; 5016 femmes agees de 25 a 49 ans ont ete depistees. Apres un consentement eclaire; la fiche d'enquete est remplie. La patiente etait confortablement installee sur une table gynecologique pour le depistage. La repartition des femmes depistees selon le niveau de la pyramide sanitaire se fait comme suit : CSCOM (19;24: 965/5016); CSRef (48;64: 2440/5016); HGT (32;12: 1611/5016). De facon generale; la positivite des tests etait la suivante : 5;2pour l'IVA et 6;8pour l'IVL. Les femmes positives au niveau des CSCOM etaient orientees vers un CSRef ou l'HGT pour la colposcopie; une biopsie eventuelle et la prise en charge. Sur 177 biopsies effectuees; les diagnostics suivants ont ete observes : 67 dysplasies; 3 carcinomes micro-invasifs; 69 carcinomes invasifs et 38 lesions inflammatoires; metaplasiques ou non concluantes. Les patientes presentant des lesions dysplasiques ou tumorales ont ete traitees par cryotherapie; conisation; resection a l'anse diathermique ou par la chirurgie. Ce travail montre que le depistage du cancer du col par les methodes visuelles est realisable au niveau des CSCOM. Nous recommandons une large diffusion de la methode sur tout le territoire national
Subject(s)
Community Health Centers , Mass Screening , Uterine Cervical Neoplasms , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiologyABSTRACT
Objective: To study the epidemiological; clinical and therapeutic aspects of upper urinary tract lithiasis at our department. Material and Methods: This is a retrospective study based on the patients' records and covering the period from January 1; 1992 to December 31; 2002. Results: During a period of 10 years; 110 cases of upper urinary tract calculi out of a total number of 7128 hospitalized patients were seen at our institution; thus constituting 1;54of all hospital admissions. The patients' mean age was 35;49 years (range: one to 75 years); the male to female ratio was 7:1. The main presenting symptom was renal colic followed by lower back pain. Treatment was mainly by open surgery (108 of 109 cases were managed by conventional surgery). Follow-up was uneventful in all cases with a mean hospital stay of 13;5 days. Conclusion: Upper urinary tract lithiasis is rarely encountered in our region; but it seems to be in constant progression. We are still obliged to resort to open surgery in most cases; although this method is not the treatment of choice in developed countries any more
