[First year results of "APAAC infos services"]. / Bilan de la première année d'activité de « APAAC infos services ¼

CONTEXT: In Ivory Coast, the APAAC association "Let us help persons living with cancer or affected by cancer", in French "Aidons les Personnes Atteintes ou Affectées par le Cancer" (APAAC), set up the first ivorian call center to support persons living with or affected by cancer and to inform population about cancer. PURPOSES OF THE STUDY: To show the feasibility of such a service in a developing country and to present the first results. METHODOLOGY: This helpline is, since January 28th, 2010, directly accessible to the population by a fixed phone number. The population can, with a local cost call, contact a specialists team (psychologist, adviser in help relation or doctor), in total confidentiality, every Thursday from 3 pm till 5 pm. Outside Thursdays, informations about cancer are available on vocal server 24 hours a day and seven days a week. Callers are welcomed by a message inviting them either to listen to a recorded message about cancer or about APAAC association or finally to speak to a specialist online. Retrospective study based on the statistics of the call center. Because of a problem arisen on the statistics software, our results carry only over the period from August to December, 2010. RESULTS: We had, during this period, 462 calls among which 23 in August, 58 in September, 67 in October, 230 in November and 84 in December. Reasons of the increasing of the figures are justify by the poster campaign in September and the communication around the service on television program in November. On these 462 calls, we had 35 real communications among whom 10 calls interrupted. The reason was the lack of call credit. The average of the call time was of 20 minutes for the conversations with the specialists. Three hundred and forty-three persons stopped to the welcome message, 341 (9%) listen information on the cancer, 27 (6%) listen information about the association. Sixteen persons wished to speak to specialists but were not regrettably able to make it because having called up except the hours of presence. Three hundred and fifty-five calls took place the working days. The most sought time slots were the ones of 7 am to 6 pm. CONCLUSION: Those results raises questions about the necessity to create and to continue this kind of telephone counseling for cancer, but also on the need of communication and extension of listening days and hours. In our country context with a population with weak resources, the necessity of access to free call was also raised.

[Difficulties with using morphine in cancer pain management: Ivorian experience]. / Les difficultés de la prise en charge par la morphine de la douleur en cancérologie: expérience ivoirienne.

UNLABELLED: Pain is the most frequent functional aspect found with cancers. Pain leads to incapacity in 69% of cases. However, pain is insufficiently handled, especially in developing countries. Pain considerably affects the quality of life of patients, and it imposes adequate care including the use of morphine when it is necessary. OBJECTIVE: To determine the difficulties to handle pain in particular with the use of morphine in order to propose some solutions. METHODS: Prospective study over six months in the Cancerology Unit of Treichville Training Hospital. It includes 120 patients who had questioning and physical examination including pain evaluation by the VAS. RESULTS: Chronic pain occurred to 96 patients (80%), pain was nociceptive for 48 patients (50%) and 19 patients (20%) had mixed pain. Morphine was relevant in 54 cases but only 27 prescriptions were made. One of the reasons was the fear of some physicians. Only eight prescriptions were respected. Six patients did not respected prescription because of unavailability whereas the remaining mentioned financial reasons as the obstacle. None adverse reaction occurred. CONCLUSION: Morphine represents a major tool to handle pain for a patient suffering of cancer. In Ivory Coast, the development of palliative care enables through national workshop to start a campaign in favor of the availability and easy geographical and financial accessibility of morphine (mainly morphine powder) whenever the prescription is required.

[Implementation of palliative care in Ivory Coast]. / Mise en place de la politique nationale des soins palliatifs en Côte d'Ivoire.

Ivory Coast adhered to the strategy of the primary cares of health whose leading principles served basis to the definition of the National politics of sanitary development, exposed in the National plan of sanitary development 1996-2005. The improvement of the quality of the cares is the main objective of this plan. The attack of this objective cannot make itself without the hold in account of the palliative cares that are a component of the cares for the patients affected by chronic and incurable affections, since the diagnosis until the death and even after the death. Conscious of the necessity to develop the palliative cares to improve the quality of life of the patients and their families, the ministry in charge of health, in collaboration with the partners to the development, initiated a project of development of the palliative care in Ivory Coast. It is about an innovating gait in Ivory Coast concerning politics of health. This work has for goal to present the big lines and the setting in which this politics has been put in place.

[Hormonal status and overexpression of HER2 in breast cancer, Cancerology department of Treichville UHC. Preliminary results]. / Prévalence des récepteurs hormonaux et de HER2 dans le cancer du sein au service de cancérologie du CHU de Treichville. Résultats préliminaires.

MAIN OBJECTIVE: determine the profile of the hormonal receptors and HER2 in order to optimize the patient's treatment by hormonotherapy and to propose targeted therapeutic to the few patients can procure themselves, when the indication is put. SECONDARY OBJECTIVES: show the feasibility of these exams in sub-Saharan Africa and also the necessity to improve the technical tray permitting to do these exams in routine thus. PATIENTS AND METHODS: Preliminary results of a prospective, descriptive study, on 10 months, achieved to the Cancerology service of Treichville CHU in Abidjan (Ivory Coast). Our results were about 22 patients. RESULTS: The middle age of our patients was of 42.7 years. The stages to the diagnosis were advanced (86%) with nodes metastasis (77%), 8 patients out of 20 were RH+ of which only one postmenopausal patient, 8 patients out of 20 were HER2+ of which 2 to 2++ and 6 to 3+++. The FISH test has been achieved for the 2 positive patients to 2 ++ by IHC and came back positive. One of patients HER2+ could have adjuvant Herceptin. CONCLUSION: Breast cancer is bad prognosis affection in our developing countries because of the patient's young age, of the advanced stages to the diagnosis. The knowledge of the status of the hormonal receptors and the HER2 over expression is necessary, as well the importance to pursue this survey and to set up an immunohistochemy unit in Ivory Coast. It will permit the realization in routine of these exams and, then, the improvement of the breast cancer patient's treatment.

Interdisciplinarité oncologues réanimateurs dans l'administration des anticorps monoclonaux aux patients atteints de cancers : expérience abidjanaise

Les thérapeutiques ciblées ont entraîné un bouleversement dans la prise en charge et le pronostic de certains cancers. Parmi elles; les anticorps monoclonaux qui ont des effets indésirables non négligeables qui peuvent être grave mettant en jeu le pronostic vital. Les auteurs rapportent leur expérience de collaboration dans l'administration et la maitrise de ces traitements dans le Service de Cancérologie du CHU de Treichville à Abidjan

[Chemotherapy in advanced rectal cancers]. / Chimiotherapie des cancers du rectum localement avances.

AIM OF THE STUDY: The aim of this retrospective study was to specify the therapeutic strategy in the management of locally advanced rectal cancers in our practice in front of lack of radiotherapy. PATIENTS AND METHODS: This study had concerned 52 patients suffering from locally advanced rectal cancers, with mean age of 44 years old (range: 22-68). Evaluation for down staging was based on clinical, CT scan and intraoperative features. Patients were classified as T4NXM0. Thirty one patients (57,7%) had left iliac colostomy associated with a neoadjuvant chemotherapy, 12 had a left iliac palliative colostomy and 9 had chemotherapy only. RESULTS: Thirty two patients (80%) suffered from digestive toxicity due to chemotherapy, 11 patients had hematologic toxicity and 4 other had skin and mucous toxicity. Between the thirty one patients who had colostomy and chemotherapy, 4 (12,9%) responded well and underwent to curative rectal resection, in the remaining patients, the colostomy stayed palliative. The median survey time was 9,5 months. CONCLUSION: Our poor results confirmed the need of early detection and radiotherapy in the management of our patients.

Cancer du sein chez la femme jeune : aspects anatomo-cliniques en milieu ivoirien

Pendant la periode 1992-1997; le cancer du sein a represente la premiere localisation des cancers dans le service de cancerologie du CHU d'Abidjan. Pas moins de 10 femmes de moins de 40 ans ont ete colligees. Le diagnostic est tardif dans 80;2 pour cent ; le type histologique le plus rencontre est le carcinome canalaire infiltrant 78 pour cent. L'envahissement ganglionnaire depassant souvent 3 ganglions 60;2 et le grade II/III 81 pour cent plaident en faveur d'un cancer de mauvais pronostic

[Secondary subdural hematoma in dural metastasis of prostatic adenocarcinoma]. / Hématome sous-dural secondaire à une métastase durale d'un adénocarcinome prostatique.

Non traumatic subdural hematoma secondary to dural metastases is a rare event but is well documented. We report a case of a 73-year-old man who presented a subdural hematoma secondary to dural metastases from prostatic adenocarcinoma. The diagnostic was made during the operation. The bone and the dura-mater were infiltrated by tumor cells. Mechanisms of transdural invasion by metastatic adenocarcinoma and production of hematoma are discussed and the relevant literature is reviewed.

Cancer incidence in Abidjan, Ivory Coast: first results from the cancer registry, 1995-1997.

BACKGROUND: There are few data concerning cancer incidence rates in contemporary West Africa. The first data from the cancer registry of Abidjan, the capital of Ivory Coast, for the period 1995-1997 are reported in the current study. METHODS: The cancer registry attempts to record data on all new cases of cancer diagnosed in the city of Abidjan, including cases without histologic confirmation of diagnosis. RESULTS: Two thousand eight hundred fifteen new cancer cases were registered in 3 years, corresponding to age-standardized (world population) incidence rates of 83.7 per 100,000 in men and 98. 6 per 100,000 in women. As reported elsewhere in West Africa, the principal cancers in men were liver cancer (15%) and prostate cancer (15.8%), with modest rates of non-Hodgkin lymphoma (10.5%) and gastric cancer (4.5%). In women, breast cancer was the most frequent tumor (25.7%), followed by cervical cancer (24.0%) and non-Hodgkin lymphoma (7.3%). In contrast to other registry data from West Africa, Kaposi sarcoma occurs with moderate frequency (7.7% of cases reported in men and 2.1% in women). In the pediatric age group, relatively high incidence rates were found for Burkitt lymphoma. CONCLUSIONS: Although there most likely is some underascertainment of cases, so that the actual incidence rates may be underestimated, the cancer profile should be a fair reflection of the true situation. In addition to tumors that are well known to be common in sub-Saharan Africa, such as cancers of the liver and cervix, this urban population shows some features of "Westernization" of cancer patterns, in particular the relatively high rates of breast cancer and prostate cancer. The effects of the acquired immunodeficiency syndrome epidemic are reflected in the moderate rates of Kaposi sarcoma reported.

Plastrons appendiculaires en Cote d'Ivoire : aspects epidemiologiques et therapeutiques

Les auteurs rapportent leur experience sur les plastrons appendiculaires a propos de 100 cas. 20 malades ont ete traites en urgence d'un plastron appendiculaire abcede. 80 sont rentres dans le protocole medico-chirurgical qui a consiste a traiter medicalement la masse qui a regresse en 10 semaines en moyenne suivi d'une intervention. La mortalite post-operatoire etait nulle et la morbidite de 15;6 pour cent representee par des supurations parietales minimes

L'antibioprophylaxie dans un service de chirurgie générale en milieu africain: étude préliminaire de 120 cas au CHU de Treichville

Les auteurs rapportent leur experience a propos de l'antibioprophylaxie en milieu chirurgical; devant les problemes poses et le cout de l'antibiotherapie l'ATB systematique de couverture. 120 patients ont ete soumis a ce protocole en fonction du degre de leur septicite de leur intervention. Le taux global d'infection post-operatoire etait de 6;6 pour cent avec une mortalite de 1;6 pour cent des cas

[Cancer of the gastric antrum. What can be expected from the systematic enlargement of the excision? Retrospective study of 73 cases]. / Cancers de l'antre gastrique. Que peut-on attendre de l'élargissement de principe des exérèses? Etude rétrospective de 73 cas.

The results of 73 consecutive curative resections for adenocarcinoma of the gastric antrum (37 distal subtotal gastrectomies and 36 electively extended total gastrectomies) are presented. The location and size of the tumour and the degree of lymph node involvement were similar in both groups (excluding superficial carcinomas), but the patients with subtotal gastrectomy were significantly older than the others (mean age : 70.5 and 59 years respectively). The operative mortality rate was 13.6% in each group, but the post-operative hospital stay was longer for total gastrectomy patients. The five-year survival rate overall (including operative deaths) was 44.3%. There was no difference in survival rate between the two types of operation (49.7% for subtotal, and 45.6% for total gastrectomy, operative deaths excluded). Survival was related to the degree of parietal spread and nodal involvement. These results are in favour of subtotal gastrectomy for antral adenocarcinoma.

[Surgery for excision of malignant duodenocolic fistulas. Review of the literature apropos of a case]. / La chirurgie d'exérèse des fistules duodéno-coliques malignes. Revue de la littérature à propos d'un cas.

Malignant duodenocolic fistula is nearly exclusively the fact of carcinoma of the hepatic flexure; it is one of the most uncommon and particular evolutive complication, because of its rapid nutritional disturbances and difficult surgical management. The authors report the case of a 78 year old man, still alive 18 months after a one staged right colectomy and pancreatico duodenectomy. The analysis of 26 others cases from literature treated with the same procedure or, most frequently, with right colectomy and partial duodenectomy allows to discuss indications and results of radical surgery: though it is possible at least in half cases, it represent a much better functional solution compared to complex by-pass procedures: more over its seems to be prognostically justifiable: out of 23 curative resected patients in this series, 6 at least (26%) are still alive from 9 to 26 years after.

[Abdomen perforating wounds. Study of 61 cases (author's transl)]. / Les plaies penetrantes de l'abdomen. Etude de 61 cas.

A recent increase in the frequency of abdomen perforating wounds has been observed in Ivory Coast, related wih social condition changes. The authors study 61 cases, recorded in 10 years. Most of the cases (62,3 p. 100) are caused by side-arms and 14,8 p. 100 by fire-arms. If 59 p. 100 of the cases resort to criminal assault, 5 p. 100 were caused by suicide attempt; the other cases were consequence of various accidents. The surgical procedures are described. Death rate, with 4 cases, was only of 6,5 p. 100.