Laparoscopic fimbrioplasty and neosalpingostomy. Experience of the Yaoundé General Hospital, Cameroon (report of 194 cases).

OBJECTIVE(S): To study the fertility results after laparoscopic distal tuboplasty and compare them with the data in the literature. STUDY DESIGN: 194 laparoscopic distal tuboplasties were carried out from May 1992 to May 1994 in the Yaounde General Hospital (Cameroon). The results were analysed according to the age of the patients, the type and duration of infertility, past history of abortion, laparotomy and Chlamydia trachomatis infection, the tube and adhesion scores, surgical procedures and achievement of pregnancy. The fertility rates were calculated according to Cramer's method [11]. The cumulative pregnancy rate curves were drawn up from the life table [12] and compared using the Log-Rank test. RESULTS: 53 patients obtained pregnancy (27.3%) of which 45 were inter-uterine (23.2%) and 8 ectopic (4.1%). Of the 45 intra-uterine pregnancies (IUP), 36 were obtained after fimbrioplasty (33.3%) and 9 after neosalpingostomy (10.5%). The monthly fertility rate at one year was 1.4%. The rate of IUP for tube stages I and II is significantly higher than that for stages III and IV (p<0.001). However the rate of ectopic pregnancies (EP) is proportional to damage to the tubes. Infection with Chlamydia trachomatis, and residual inflammation could have an effect on the achievement of pregnancy. CONCLUSION(S): Our results are similar to those found in the literature. The tube stage thus remains the decisive factor in terms of fertility (Cox: p<0.001). Operative laparoscopy is the best alternative in our countries compared with laparotomy for distal tubal pathology.

[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.

[Posterior urethral valves in children. Apropos of 22 cases]. / Les valves de l'urètre postérieur chez l'enfant. A propos de 22 cas.

We reviewed 22 cases of posterior urethral valves over a five year period (January 1986 to December 1990). We looked at initial management before referral to the urologist, treatment and those factors that influence the outcome. We found that nosocomial infection from catheters was the major source of morbidity and mortality. Other determinants of outcome included postobstructive diuresis and the presence of refluxing or obstructing megaureters. The age of the patients was not as important as the degree of obstruction in this group of patients. We recommend percutaneous cystostomy as initial management for these patients as opposed to urethral catheterisation. This should be followed by antegrade or retrograde valve ablation one week later depending on the size of urethra.

[Failure of medical treatment with antihypertensive agents in a child with pheochromocytoma. Recovery after surgery]. / Echec du traitement médical antihypertenseur chez un enfant porteur d'un phéochromocytome. Guérison opératoire.

Anaesthesia for removal of pheochromocytomas requires preoperative preparation of patients so as to normalize blood pressure. During operation, hypovolemia linked with the sudden fall of circulating catecholamines as well as hypertension during handling of the tumor are to be managed. A case of a 11 year child with pheochromocytoma is reported. Once the diagnosis had been established, various attempts to normalize blood pressure failed. Despite a precarious condition, the operation could be performed. During surgery, hypertension occurred and three hypotensive drugs failed to correct it. It ceased after removal of the tumor. The postoperative course was uneventful. The authors discuss the role of the type of catecholamines and their concentration in the failure of antihypertensive medication.