Decompensated cirrhosis and pregnancy: a case report.

The association of decompensated cirrhosis and pregnancy is rare. Portal hypertension exposure to gastrointestinal bleeding from a ruptured esophageal varix may at any time complicate the course of the disease. We report the case of a 24-year-old patient who delivered at 35 weeks/four days of gestation with decompensated cirrhosis secondary to viral hepatitis B; icterus, oedema, and ascites were present. The postpartum course was uneventful despite the biological disorder of coagulation.

Leiomyomatosis peritonealis disseminata and pregnancy: a case report.

Leimyomatosis peritonealis disseminata (LPD) is a benign tumor of smooth muscle tissue. It is rare and is characterized by the development of multiple peritoneal nodules mimicking peritoneal carcinomatosis. We report a case of LPD diagnosed in a 35-year-old patient, G4/P1, without any major gynecological history. The patient underwent an elective cesarean section at 42 weeks, during which numerous peritoneal nodules ranging in size from 0.1 to 0.5 cm were found. Microscopic examination showed a proliferation of smooth-muscle cells without mitosis or atypia or necrosis.

Endometrial osseous metaplasia and infertility: a case report.

Endometrial osseous metaplasia is a rare clinical entity. It causes infertility and occurs in more than 80% of cases after an abortion. Various theories have been proposed and the most accepted theory is metaplasia of the stromal cells into osteoblastic cells that produce bone. This disease may be misdiagnosed. However once diagnosed, the complete removal of bone spicules by hysteroscopy allows, in most cases, fertility to be restored. We present the case of a 36-year-old patient nulliparous with a history of abortion for eight years who consulted May 5, 2008 to become pregnant. Detailed examination showed chronic endometritis with bone metaplasia as a possible cause of her infertility. Seven months after complete removal of bone fragments by hysteroscopy, the patient had a spontaneous pregnancy with normal development. She gave birth to a male infant weighing 3,000 g with an Apgar score of 9 at 1 and 5 min. Delivery and postpartum were normal.

[Placenta praevia: maternal and featal prognosis in University Hospital of Cocody (Abidjan-Cote d'Ivoire)]. / Placenta Praevia: Pronostic Maternel et Foetal au Chu de Cocody (Abidjan- RCI).

INTRODUCTION: In Africa, in spite of systematical practice of echography, Placenta praevia (PP) remains a high risky gravid complication, very unpredictable, with a high lethality rate. OBJECTIVES: The aim of our study was to reconsider the frequency of this pathology, to appreciate the maternal and fetal prognosis. PATIENTS AND METHODS: This was a retrospective cohort study, about 340 cases of PP, at the University Hospital of Cocody in Abidjan, during 5 years, from January 1st 2002 to December 31st 2006. We included in this study all the parturients with a gestational age > or = 28 weeks of amenorrhea, and a PP diagnosed during either pregnancy, or labour, or after placenta stage. Maternal age, parity, gynecologic and obstetrical antecedents, mode of delivery and maternal and fetal prognosis was compared between patients with PP and a group of witness chosen among normal pregnancies. The comparison has been done by using X² and Fischer test with a threshold of signification of 5%. RESULTS: The frequency of PP in our study was 1.6%. The maternal age was > or = 30 years old for 43.2% of patients with PP against 28% in witness group (p=0.000). Among cases of PP, multiparous and high multiparous represented 37.7% against 10% in the witness group. Healing uterus was an increasing factor of PP (32 cases against 8 in witness group; p=0.024). Caesarean operation has been the principal mode of delivery among the patients with PP (80%). 43.8% of newborn was premature against 8.5% in the witness group (p=0.0000). The perinatal mortality was 21.3% in cases of PP against 3.8% in witness group. Three maternal deaths (0.9%) have been noticed among patients with PP. CONCLUSION: The management of PP is still badly definite in Africa. The early diagnostic by ultrasound examination permit an adapted supervision and the prevention of all obstetrical complications of this pathology.

Primitive breast localisation of Buruli ulcer in an endemic zone: a rare case.

A case of Buruli ulcer with primitive breast localisation with evident epidemiological and clinical aspects is reported. This localisation is exceptional; the differential diagnosis with breast cancer is essential. If diagnosed early, it can be cured with surgery, broad-spectrum antibiotherapy and thermotherapy.

[Cervical cancer: epidemiology and medical assistance in African society]. / Le cancer du col de l'uterus: aspects épidémiologiques et prise en charge en milieu Africain.

OBJECTIVES: The aim of this study was to improve the medical assistance and the prognostic of cervical cancer in African society. MATERIALS AND METHODS: It was a retrospective and descriptive study carried out in the gynecology and obstetrics department at the teaching hospital of Cocody. It spanned over five years, from January 1st, 2002 to December 31st, 2006. It was focused on 171 cases of cervical cancer histologically confirmed. RESULTS: The frequency of cervical cancer in that study was 1.7%. Patients had an average age of 48.5 years. 38.7% of patients were aged between 41 and 50. Multiparous represented 73.1% of patient with a majority of 38.6% for seven births and more. Patient socio-economic background was low in 72% of cases, married and divorced patients represented 63.2%. Patients who had an early sex and those with numerous partners respectively represented 77.2% and 73.2%. In 70.2% of cases, they had suffered a sexually transmitted infection once. Extension rate was limited to the financial capacities of our patients. Operable stages represented 19.3% and belated stages 57.1%. Only 8.8% of our patients were operated. The average theoretical cost of the surgical treatment was 298.203 F CFA. CONCLUSION: This study showed that to improve medical assistance to patients, it is (capital) urgent to face efficiently the out break of factors of risk and improve diagnosis and therapy.

Le cancer du col de l'uterus : aspects epidemiologiques et prise en charge en milieu africain

Objectifs : Ameliorer la prise en charge et le pronostic du cancer du col de l'uterus en milieu africain. Materiels et methodes : Il s'agissait d'une etude retrospective et descriptive realisee dans le service de gynecologie et d'obstetrique du CHU de Cocody. Elle s'est deroulee sur cinq ans; du 1er Janvier 2002 au 31 Decembre 2006. Elle a portee sur 171 cas de cancer du col de l'uterus histologiquement confirme. Resultats: La frequence du cancer du col de l'uterus dans cette etude etait de 1;7. La moyenne d'age des patientes etait de 48;5 ans. Elles avaient un age compris entre 41 et 50 ans dans 38;6des cas. Les multipares representaient 73;1avec une majorite de 38;6pour 7 enfants et plus. Le milieu socioeconomique etait bas (72). Les patientes mariees et divorcees representaient 63;2. La precocite des rapports sexuels et le multipartenariat sexuel etait respectivement de 77;2et 73;2. Elles avaient un antecedent d'infection sexuellement transmissible dans 70;2des cas. Le bilan d'extension a ete limite aux moyens de nos patientes. Les stades operables representaient 19;3et les stades tardifs 57;9. Seulement 8;8de nos patientes ont ete operees. Le cout theorique moyen du traitement chirurgical a ete de 298. 203 F CFA. Conclusion : Il apparait urgent que pour ameliorer la prise en charge des patientes; de lutter efficacement contre la recrudescence des facteurs de risque et d'ameliorer le plateau diagnostic et therapeutique