Prise en charge chirurgicale du cancer de l'ovaire au CHU de Brazzaville

Les cancers de l'ovaire sont ses maladies graves au pronostic souvent sombre. Ils occupent la premiere place parmi les causes de deces par cancer gynecologique. Au CHU de Brazzaville; ces cancers ont ete diagnostiques au stade avance d'ou les difficultes dans leur prise en charge chirurgicale. En consequence notre objectif a ete d'etudier la place et les caracteres de la chirurgie dans la prise en charge de ces cancers. En 11 annees (1er janvier 1998-31 decembre 2008) 9946 patientes ont ete operes dans notre servie dont 29 pour le cancer de l'ovaire soit 0;29. Parmi ces patientes 28 etaient a des stades avances (IIc; III et IV). La chirurgie radicale elargie avec curage a ete pratiquee dans 62;1des cas qui etaient aux stades II et IV. Nous avons enregistre 17 complications dont quatre deces aux 10eme et 18eme jours post-operatoires. La pratique des examens echographiques systematiques pourraient ameliorer les resultats du traitement chirurgical en proposant des gestes moins mutilants devant des stades moins avances

[Arterial hypertension: epidemiological aspects and risk factors on pregnant and delivered woman]. / Hypertension artérielle: aspects epidémiologiques et facteurs de risque chez la gestante et l'accouchée.

OBJECTIVES: Determine frequency of hypertension in pregnancy and delivered women at the Teaching Hospital of Brazzaville and identify epidemiological aspects and risk factors. PATIENTS AND METHODS: A prospective and transversal study was realized from november 2004 to january 2005 in the Teaching Hospital of Brazzaville. Forty two patients (8 pregnant women, 34 delivered) with hypertension, have been enregistered among 825 admissions in the departments of gynecology and obstetric. Arterial hypertension was defined by a blood pressure at 140/ 90 mm Hg or above. RESULTS: Arterial hypertension constituted 5.1% of the total admissions. Average of the patients was 27 +/- 8 years (age range: 14 and 40 years). Two patients (4.8%) haven't been sent to school, 29 (69%) had the secondary level, twenty (47.8%) were housewives. Seventeen patients (40.5%) had realized 2 prenatal consultations at the most. Patients were divided in 4 groups: Chronic hypertension (n = 4), pre eclampsia surimposed on chronic hypertension (n = 4), pregnancy hypertension only (n = 15), preeclampsia (n = 19). Prim gravidity (38.1%) and family history of hypertension (40.4%) were the most frequent risk factors. Obesity, gemality, previous pre eclampsia represented respectively 14.3%, 9.5% and 4.8%.

[Preterm births at Brazzaville University Hospital]. / Naissances avant terme au CHU de Brazzaville.

The objectives of our study were to assess the frequency, causes and outcomes of preterm births in Brazzaville University Hospital and to improve our obstetric and pediatric management. We retrospectively studied all births during 1994: 5109 in all. We collected information about the circumstances of preterm birth and all available information about its causes, mode of delivery, and immediate 24-h outcome. There were 852 preterm births (16.7% of all births). Mothers aged 14-20 years accounted for 27% of these births, while those 35 years or older accounted for only 9%. The 24-h survival rate was 73.7% (n=628). Those born at a gestational age of 28-30 weeks accounted for 40.7% of the deaths. The principal causes in order of frequency were: premature rupture of membranes (48%, caused by infection in 68% of cases), complications of high blood pressure (23.9%, including eclampsia, abruptio placentae and HELLP syndrome), twin pregnancies (14%), and previa placenta and hemorrhage (7%). The average time until the baby's transfer to neonatal intensive care was 12 hours, often because of an absence of beds. The principal causes of such transfer were: neonatal infection (48%), respiratory distress (27%) and gestational age less than 33 weeks (22%). Prognosis for preterm births is better at Brazzaville University Hospital at and after 33 weeks; extreme prudence is required before this term, especially for cesarean deliveries.

[Sexual violence in Brazzaville]. / Violences sexuelles à Brazzaville.

UNLABELLED: This six-year retrospective study (1998-2003) reviewed the records of 102 women or girls examined in the hospital gynecology department at the official request of the police. We examined the following variables: social and demographic characteristics of the victim and the perpetrator (age, occupation, residence); their relationship, if any; type of contact; injuries caused by the rape. Of a total of 102 cases, we observed an important peak in 1998 (35.5%) and a significant fall in 2003 (5.9%). All age brackets were involved. 46.1% of the victims were aged 11 to 15 years, and 37.3% of the attackers from 21 to 25 years. The oldest perpetrator was 56 years; his victim was 11. The youngest victim was 4 years old and 8 months and her attacker was 14. Sexual violence reported to the police and referred to our unit involved primarily persons in the lowest socioeconomic category (86.3%). The nature of the relationship between the criminal and the victim varied: in 57.9% of cases the victim knew the attacker and in 42.1%, she did not. Offers of money preceded the rape in 40.2% of the cases, while it began with physical constraint in 47%. Rape most often involved penetration of the vagina by the penis (80.4% of cases); fellatio and sexual contact with the finger accounted for only 6.9% and 12.7%, respectively. An 11 year-old girl had vulvo-vaginal irritation without cloaca. Genital infections were observed in 15 cases (14.7%), and HIV serology present in 2 (2%). On the psychological level, two girls presented depressive syndromes and did not speak the day of their examination. CONCLUSION: Sexual violence is frequent in Brazzaville. This study, while very far from exhaustive, provides an idea about the extent of the phenomenon. Sociopolitical disorders most probably amplified this phenomenon in our society. Although physical lesions were seldom noted, the sexual aggression caused psychic damage for life and presented the risk of HIV transmission. Peace and security are the primary means of combating this plague. Education targeted at potential attackers, in particular men at arms, should not overshadow the legal measures envisaged by the legislation in this field.

Choriocarcinome tubulaire primitif

A partir d'un cas de Choriocarcinome tubulaire primitif diagnostique au CHU de Brazzaville. Les auteurs analysent la frequence; le diagnostic; le traitement et le pronostic de cette pathologie dans le contexte des pays en developpement

[Risk factors of intrauterine growth retardation in Congo]. / Facteurs de risque de retard de croissance intra-utérin au Congo.

A case-control study was performed between April 1st and September 30th to investigate determinants of intrauterine growth retardation (IUGR) in 3 centers in Brazzaville, Congo. Each patient group included 539 neonates. Cases were newborns with birth weight below the 10th percentile of the Leroy and Lefort curve. Risk factors of IUGR identified with univariate analysis were: maternal age<20 years, low educational level, unmarried woman, low social and economic status, primiparity, low birthweight of previous child, low interpregnancy interval, number of prenatal examinations<4, maternal weight gain during pregnancy<5kg and malaria. Multivariate analysis retained 3 risk factors: low educational level, low social and economic status, and maternal weight gain during pregnancy<5kg. This study enabled us to identify certain risk factors of IUGR useful for establishing a prevention strategy.

[Maternal mortality in Brazzaville (1993-1994)]. / Mortalité maternelle à Brazzaville (1993-1994).

OBJECTIVE: The purpose of this cross-section study is: to determine the maternal mortality rate in Brazzaville, Congo; to identify the main pathologies and associated risk factors; to suggest appropriate courses of a action in order to reduce the mortality rate. STUDY DESIGN: Records from the Brazzaville Central Hospital, the morgue and the city districts were used to study all the cases of women aged 15 to 44, who died from May 1 1993, to April 30 1994. Cases of maternal mortality were selected. RESULTS: One hundred forty-three cases of maternal death were registered for 35,000 live births, giving a rate of 408 per 100,000 live births. Death in childbirth represents the third mortality factor in mothers-to-be, well behind AIDS and respiratory infections. The main direct factors are: obstetrical hemorrhagies (40.55%), post-abortion infections (18.85%), post-delivery infections (12.69%), eclampsia (11.18%), AIDS (4.19%). AIDS is the main indirect obstetrical and the primary mortality factor in mothers-to-be. CONCLUSION: These findings suggest that the reduction of maternal mortality in Brazzaville has to be correlated with: the need for widespread information about the importance of pre-natal consultations, the need for efficacious action against the spreading of AIDS by common use of condoms, the fight against clandestine abortions, the provision of hospitals with appropriate equipment for the treatment of emergencies.

[Uterine rupture in an African environment. 59 cases at the University Hospital Center in Brazzaville]. / Les ruptures utérines en milieu africain. 59 cas colligés au CHU de Brazzaville.

A retrospective study of 59 uterine ruptures was conducted at the University Hospital in Brazzaville. The frequency fo uterine ruptures in this institution was found to by 0.7% among the 8,138 women who delivered between 28 ans 42 weeks amenorrhoea. The duration of this study was 26 months from 1 September 1989 to 31 October 1991. The mean age of the women was 26.5 years. Most had been transferred from peripheral centres (84.7%). The predominant aetiological circumstances were: multiparity (94.9%), cicatricial uterus (35.6%), poorly controlled use of ocytocic agents (32.2%) and mechanical dystocia (30.5%). The uterine ruptures were often complete (64.4%) and diagnosed in the perpartum period (54.2%). Maternal and foetal outcome was often fatal with 4 maternal deaths (6.7%) and 40 foetal deaths (67.8%). The main effort for prevention and reduction of this dramatic situation in Africa requires personnel training, equipping peripheral centres and improved highway system in order to allow rapid access to well equipped hospitals.

[Clinical presentation of non-pernicious malaria attacks in patients hospitalized in Brazzaville (Congo) in 1989]. / Présentation clinique des accès palustres non pernicieux hospitalisés a Brazzaville (Congo) en 1989.

The clinical manifestations observed in 102 malaria patients (parasitaemia of over 8,000 Plasmodium falciparum/mm3) hospitalized in 1989 in Brazzaville (Congo) were analyzed after ruling out the cases of pernicious malaria. The clinical picture was fever, stomach upset with headache and musculo-articular pain as in classical cases. In children these manifestations were frequently associated with convulsions. Diarrhoea was not uncommon in young children. Vomiting was frequent in both children and adults. Splenomegaly and hepatomegaly were closely related to age. In these subjects, chemoprophylaxis was rare in children, practically non-existent in those aged over 5 years. However, presumptive treatment and self medication was usual regardless of age.

[Pathology of breast tumors occurring before the age of 30 in Brazzaville]. / Pathologie tumorale mammaire avant l'âge de 30 ans à Brazzaville.

In 42 months, 175 patients (171 women and 4 men) were followed for mammary tumor in the Department of Medicine and Cancerology of l'Hopital General of Brazzaville. Among them, 63 files were retained for the study, corresponding to women under the age of 30. The study of these cases enabled the authors to establish the relatively important frequency of large tumors (larger than 5 cm), and the similarity of the general aspects of the pathology of mammary tumors, as compared to european studies.

[Inflammatory cancer of the breast. Assessment after 6 years of 16 patients treated by primary immunochemotherapy]. / Cancer inflammatoire du sein. Bilan à six ans de 16 malades traitées par immunochimiothérapie première.

Sixteen patients with clinical primary inflammatory carcinoma of the breast were treated with initial immunochemotherapy from September 1974 to May 1977. This chemotherapy was an association of adriamycin, vincristine, fluorouracil, methotrexate, and melphalan. Thermographic cooling was taken as the criterion of operability. Chemotherapy was resumed after surgery up to a total of ten periods, and followed by a minimum one year chemotherapy. I-BCG-F Pasteur was used as immunotherapy and associated with the chemotherapy regimen. Five patients have died, four are alive with disease, and seven are free of disease at time of reporting. Median survival exceeds 90 months. Our data supports the conclusion that mastectomy combined with preoperative and postoperative immunochemotherapy may permit a better prognosis for inflammatory carcinoma of the breast: this benefit seems to be the consequence of adapting the length of initial chemotherapy to the data given by plate-thermography.

[Acute pancreatitis in the puerperium. Diagnostic problems following cesarean section]. / Pancréatite aiguë de la puerpéralité. Problèmes diagnostiques dans les suites de césarienne.

A case is reported of acute pancreatitis following caesarean section. This complication, which is fortunately very rare, shows the diagnostic steps we had to take, in an obstetrical department, to arrive at the answer. The serious consequence of the outcome, if untreated, let us to emphasize: The need for rapid diagnosis, and Early treatment of the cause. Only these methods make it possible to improve the prognosis, which is very bad indeed when acute pancreatitis occurs in the post-partum phase, as the literature emphasizes.