Pronostic de la rupture utérine au cours du travail : à propos de 293 cas colligés au CHU de Bouaké (Cote d'Ivoire)

L'objectif a été de préciser la fréquence de la rupture utérine au sein de la maternité du CHU de Bouaké et de déterminer le pronostic en fonction de l'éloignement du CHU de Bouaké. Il s'agit d'une étude rétrospective et comparat ive qui s'est déroulée du 1er janvier 1996 au 31 décembre 2001. Cette étude a comparé les caractéristiques et le pronostic materno-fœtal de deux types de patientes : celles issues d'un périmètre de sécurité sanitaire arbitraire défini de 100 kilomètres autour de la ville et celles issues de localités situées au-delà. La fréquence de la rupture utérine a été de 2,44 % soit une rupture utérine pour 41 accouchements. L'hystérectomie a été plus pratiquée dans la population des femmes issues de localités situées au-delà du p é ri m è t re de sécurité sanitaire : 83,34 % contre 28,57 % (p < 10- 4). La létalité de la ru p t u re utérine a été de 11,26 % pour l'ensemble des patientes avec une surmortalité pour celles venues de localités au-delà du périmètre de sécurité sanitaire : 29,91% c o n t re 8,97 % pour celles du péri m è t re de sécurité sanitaire (p = 0,0052). La mortalité fœtale a été de 100 % pour les patientes hors du périmètre de sécurité sanitaire. Les patientes présentant une rupture utérine et évacuées de localités situées au-delà du périmètre sécurité sanitaire ont un pronostic materno-fœtal beaucoup plus sombre

[Primary non-Hodgkin's lymphoma of the liver: report of two cases and review of the literature]. / Linfoma não Hodgkin primitivo do fígado: relato de dois casos e revisão da literatura.

Two cases of primary non-Hodgkin lymphoma of the liver are presented, with comments about the main clinical and pathological aspects of the disease based on literature review. Both patients were woman (19 and 62 years old) and presented the same complaints: severe weight loss and presence of fast growing abdominal mass. In both cases the histologic diagnosis showed a non-Hodgkin, diffuse, large cell lymphoma (centroblastic-centrocytic diffuse lymphoma) with intermediate grade of malignancy. One case (19 years) died before treatment. The autopsy showed a large solitary tumor (18 cm in diameter) in the right liver lobe and two small nodules (1 cm) in the subcutaneous tissue of the abdominal wall. The other case (62 years), was treated by partial hepatectomy and chemotherapy. There was a round, solitary tumor (8 cm in diameter) in the left lobe. The patient remains without manifestations of disease relapse 18 months after the treatment. In both cases the tumor did not spread to lymph nodes, spleen and other viscera.

[Alcoholic hepatitis: clinical, laboratorial and histological study of 50 cases]. / Hepatite alcoólica: estudo clínico, laboratorial e histológico de 50 casos.

The clinical, laboratorial and histological aspects of 50 cases of alcoholic hepatitis were analysed, as well as the follow-up of 24 patients. The mean age of the 50 patients was 42,9 years (range: 25 to 65 years); 44 were males. The beginning of the symptomatology was insidious in great number of cases. The hepatomegaly was most habitual clinical signal (92% of cases). The jaundice was observed in 58% of the cases. Twenty six per cent of the patients had not manifestation of advanced hepatopaty at the moment of diagnosis. The most constant laboratorial alteration (except the increase of gama-glutamil-transpeptidase, dosed in rare cases) was the increase of SGOT (94%). Histological examination showed necrosis and inflammatory exudate in all cases; steatosis in 98%; Mallory bodies in 78%; fibrosis in 84%; cirrhosis in 44%. In the group of patients that came to the obit at the first internation, jaundice, digestive bleeding, encephalopathy, infection, leucocitosis and decreased prothrombin activity. The follow-up of 24 cases (3 months to 5 years) showed aggravation of illness and frequent evolution to cirrhosis in patient that maintained the alcohol ingestion.

Hepatite alcoolica: estudo clinico, laboratorial e histologico de 50 casos. / Alcholic hepatitis: clinical, laboratorial and histological study of 50 cases

Os aspectos clinicos, laboratoriais e histologicos de 50 casos consecutivos de hepatite alcoolica sao analisados, bem como a evolucao tardia de 24 pacientes. Quarenta e quatro eram masculinos, a idade variando de 25 a 62 anos, com media de 42,9. Na maioria dos casos, o inicio da sintomatologia foi insidioso. A hepatomegalia foi o sinal clinico mais comum (92%); ictericia foi observada em 58% dos casos. Vinte e seis por cento dos pacientes nao apresentavam sinais ou sintomas sugestivos de hepatopatia avancada, na epoca do diagnostico. A alteracao laboratorial mais constante, excluindo a dosagem da gamaglutamil-transpeptidase (dosada em poucos casos), foi a elevacao da transaminase oxalacetica (94%). Histologicamente observamos necrose e infiltrado inflamatorio em todos os casos, esteatose em 98%, corpusculo de Mallory em 44%. No grupo que evoluiu para o obito na primeira internacao, foram significativamente mais frequentes a ictericia, hemorragia digestiva, encefalopatia, sinais de infeccao leucocitose e baixa atividade de protrombina.Em 24 casos acompanhados (3 meses a 5 anos) observou-se piora do quadro e alta frequencia de evolucao para cirrose, nos pacientes que mantiveram o alcoolismo

The association of hepatitis B surface antigen (HBs Ag) with hepatocellular carcinoma in Espírito Santo State, Brazil.

1. The occurrence of hepatitis B surface antigen (HBs Ag) was investigated in 46 cases of hepatocellular carcinoma (HCC) diagnosed in Vitória, Espírito Santo State, Brazil. 2. Twenty cases were patients in which the HCC was diagnosed by biopsy, laparoscopy or on autopsy from 1977 to 1980. HBs Ag was measured in the serum by reverse passive hemagglutination (13 cases) and radioimmunoassay (7 cases). Twelve cases (60%) were HBs Ag positive. 3. The presence of HBs Ag was studied in 26 cases diagnosed on autopsy using paraffin-embedded liver sections stained with orcein. Eleven cases (42%) showed orcein granules in hepatocytes surrounding the tumor. In only one case were orcein-positive granules detected in the tumor cells. 4. The 50% incidence of HBs Ag among patients with HCC is higher than the occurrence of HBs Ag in the general population of the State of Espírito Santo, i.e. 3.5% among 1300 blood donors to the University Hospital. 5. These data provide additional evidence for the hypothesis that there is a relationship between the hepatitis B virus and the etiology of HCC.