[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.

[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.

[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

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