[Primary lymphomas of the urinary in the urological service of the Yaounde Central Hospital]. / Les lymphomes primitifs urogénitaux : l'expérience du service d'urologie de l'hôpital Central de Yaoundé (Cameroun).

OBJECTIVE: The objective of this study were to recruit and present epidemiological, clinical, histological and therapeutic aspects of primary lymphomas of the urogenital tract in Cameroon. MATERIAL AND METHOD: This was a retrospective study over a 10-year period (1999-2008) done on clinical records of the Urological Unit of the Yaounde Central Hospital. From these records, we noted the age and the sex of the patients, their clinical presentation and histological aspect. The patients were treated by surgical resection and chemotherapy. RESULTS: Twenty cases were recruited between this period of the study. The age of the patients varied from 6 to 60 years with a mean age of 35 years. There were 19 men and one woman. Eighteen cases involved the testis, one case the kidney and one penile involvement. On histology, there were 19 cases of Burkitt's lymphoma and one case of large B cell lymphoma involving the penis. Three patients had positive syphilis serology and two other were HIV positive. All the patients in this series had a complete remission after treatment but the tumour recurs after 6 to 9 months. CONCLUSION: Burkitt's lymphoma is the first malignant tumour of the testis in Cameroonian. Unfortunately, patients consult late, there are no supports for the treatment and this will lead to a poor prognosis.

[Analysis of operative indications and outcomes in 238 re-operations after abdominal surgery in an economically disadvantaged setting]. / Réinterventions de chirurgie abdominale en milieu défavorisé : indications et suites opératoires (238 cas).

AIM OF THE STUDY: We analyse aspects of re-operative abdominal surgery in an economically disadvantaged environment with respect to indications, operative findings, treatment modalities, and outcomes. PATIENTS AND METHODS: Retrospective chart review over a seven-year period of patients requiring re-operative surgery during the same hospitalization or within 30 days of initial surgery. RESULTS: During the study period, 7714 laparotomies were performed. Two hundred and seventy-seven (3.6%) required re-operation; of these, 238 charts (86%) were able to be reviewed. The decision for operative re-intervention was made mainly on the basis of clinical findings. Postoperative peritonitis (50.8%), adhesive bowel obstruction (23.9%), and intestinal fistula (10.9%) were the main indications for re-intervention. Complications occurred in 35% and included postoperative infection (n=70, 33%) and abdominal wall dehiscence (n=37, 15.5%). Mortality was 18% and increased significantly when the initial operative procedure was for peritonitis and re-operation was due to septic complications. CONCLUSION: In an economically disadvantaged environment, the re-operation rate after an abdominal surgery does not seem to be higher than that seen in series from developed countries, although there may be factors which bias this observation. The mortality rate for cases with postoperative peritonitis is high, but operative re-intervention based on clinical findings is still considered the favored strategy in our environment. Results may improve with better material medical conditions.

[Acute abdomens of parasitic origin: retrospective analysis of 135 cases]. / Les abdomens aigus d'étiologie parasitaire: analyse d'une série rétrospective de 135 cas.

OBJECTIVE: To assess acute abdomens incidence of parasitic origin at Yaounde (Cameroon) and evaluate their different management modalities. MATERIALS AND METHODS: Retrospective study from January 1973 to December 2002 of patients managed at Department of Surgery, Central Hospital, Yaounde (Cameroon). RESULTS: Among 3464 acute abdomens managed by laparotomy during this period, 135 patients (3.9%) had a parasitic origin. Ninety-seven patients (79%) were operated on before 1990. Among these 135 patients, 63 (47%) had peritonitis secondary to liver amoebic abscess intraperitoneal rupture, 24 (18%) had acute intestinal obstruction due to an ascaridioma, 21 (15%) had appendicitis of parasitic origin, 15 (11%) had amoebic typhlitis, 4 (3%) had pancreatitis and/or angiocholitis caused by the obstruction of ampulla of Vater by an adult ascaris worm, 4 (3%) had intestinal perforation by ascaris, and 4 (3%) had intussusception (tricocephalus). CONCLUSIONS: Incidence of abdominal emergencies of parasitic origin is unfrequent but not rare at Central Hospital, Yaounde, Cameroon. This incidence is decreasing over time. However, liver amoebic abscess intraperitoneal rupture is the most common cause of peritonitis and is still associated with postoperative high mortality rate. Preoperative diagnosis could lead to non-operative management that may be associated with better prognosis.

[Traumatic jejuno-ileal ruptures: apropos of 18 cases at the Central Hospital of Yaounde]. / Les ruptures traumatiques jéjuno-iléales: àpropos de dix huit (18) observations àl'hôpital Central de Yaoundé

Eighteen blunt small bowel traumas were reviewed in this retrospective study (1986-1996) concerning 12.8% of laparotomies for blunt abdominal trauma. The clinical presentation at admission was peritonitis (9 cases) or hemoperitoneum (4 cases) whereas 5 cases were diagnosed lately because of non specific signs at the beginning. All patients underwent surgery: simple suture or suture after excision of edges (12 cases); resection anastomosis (6 cases). There were no post-operative complications in most of the cases. The mortality rate was 5%. Blunt small bowel traumas are not frequent in our practice. Their diagnostic is often per-operative. If the clinical signs of intraperitoneal lesion are not present, a clinical follow-up by repeated and thorough physical examination can permit an early diagnosis. The surgical treatment is simple, and the prognosis more linked to severe associated lesions than the bowel lesion.

[Blunt trauma of the liver. An analysis of a series of 29 cases]. / Traumatismes fermés du foie. Analyse d'une série de 29 cas.

Twenty nine patients with blunt liver trauma were recorded in the Central Hospital of Yaounde between 1986 and 1996. The average age was 23.4 years, with the 20 to 25 and 5 to 15 age groups being the most affected. The most characteristical clinical presentation was hemoperitoneum with shock. Twenty-three patients were operated (18 in emergency and 5 secondary). While 6 patients benefited from non operative treatment due to their stable hemodynamic state. Exploration of lesions revealed 16 grade I and grade II, 8 grade III and 5 grade IV and V lesions. The operation was a simple suture in 13 cases, selective ligature of hepatic artery in 2 cases and 2 tamponades while in 4 cases the treatment was inactive. The bleeding could not be controlled in 2 cases. Peri-operative mortality was 17.39% and morbidity 21.74%, made up mainly of parietal sepsis. In our practice, blunt liver trauma are generally benign and treatment should be conservative.

[Liver trauma: analysis of 42 cases in Yaounde]. / Traumatismes hépatiques: analyse d'une série de 42 cas à Yaoundé.

Forty-two cases of liver trauma were reviewed at the Central Hospital of Yaounde between 1984 and 1994. The mean patient age was 22 years, the most commonly involved age group being between 20 and 35 years. Trauma was blunt in 24 cases (57.1%) and penetrating in 18 cases (42.8%). Diagnosis was achieved most frequently by abdominal needle puncture confirming hemoperitoneum. Emergency surgery was performed in 38 cases. In the remaining 4 cases hemodynamic status was stable and surgery was not required. Lesions were classified as grade I and II in 24 cases, grade III in 5 cases, grade IV in 3 cases, and grade V in 1 case. In the remaining 9 cases the grade of the lesion was not mentioned. Management consisted of simple suture in 26 cases, debridement in one case, packing in 4 cases, and a watchful attitude in 4 cases. In 3 cases hemorrhage was uncontrollable. Overall perioperative mortality was 14.2%. The main complication was parietal sepsis which occurred in 6 cases. In the present African series liver trauma was most often benign. This finding suggests that a conservative surgical approach is indicated.

[Developing cancer from a probable misdiagnosed pancreatic cystadenoma]. / Cancérisation d'un probable cystadénome pancréatique méconnu.

This paper reports the malignant transformation of a benign pancreatic cyst treated by internal drainage in a 30-year-old woman. The initial lesion was diagnosed on surgical biopsy of the cyst wall. The diagnosis of pancreatic carcinoma was made after one year of satisfactory course, by fine needle cytologic aspiration of the fibrous retraction of the cyst; at that time the patient had severe pancreatic pain with multinodular liver on ultrasonography. The conclusion is the recommendation of total excision of pancreatic cysts whenever the diagnosis is incomplete or imprecise.

Perforation traumatique du grele et engagement occasionnel du taenia saginata : a propos de 2 observations. [Lettre]

L'engagement occasionnel de parasites a travers une breche intestinale; en dehors de l'ascaris; est un fait assez rare au Cameroun. La presence intraperitoneale du taenia saginata confirme l'hypothese d'une utilisation accidentelle par le parasite d'une perforation pre-existante. Cette presence ne modifie pas le cours de l'intervention. Le traitement antiparasitaire post-operatoire complete la destruction parasitaire mecanique peroperatoire

[Primary abscess of the psoas. A common disease in tropical countries. Apropos of 87 cases]. / Abcès primaires du psoas. Affection courante en milieu tropical. A propos de 87 cas.

Over a 4 years period, 87 cases of primary abscesses of the psoas were treated surgically at the Central Hospital in Yaoundé. The psoas muscle was involved in 10.17% of the cases with myositis. Most patients were in young male and the abscesses were in an advanced stage. Staphylococcus was the most frequently encountered germ (78.4%) and enterobacteria were only found in 3.07%. The diagnosis was based on clinical and echographic findings. There was 1 patient with acquired immunodeficiency syndrome (AIDS). Most cases were treated by extraperitoneal drainage. Morbidity and mortality were low and generally occurred in debilitated patients (AIDS, involvement of several muscle groups, diabetes).

[A rare complication of inguinal hernia. Evisceration by rupture of the scrotum secondary to blunt trauma of the abdomen]. / Une complication rare de hernie inguinale. Eviscération par rupture scrotale secondaire à un traumatisme appuyé de l'abdomen.

The authors present a case report of scrotal rupture with evisceration from abdominal contusion in a patient with a voluminous inguino-scrotal hernia. The mechanism and treatment of lesions are discussed.

[Ano-rectal injuries in civilian practice in Cameroon. 10 case reports]. / Les plaies ano-rectales en pratique civile camerounaise. A propos de 10 cas.

At the Central Hospital of Yaoundé, Cameroon, 10 ano-rectal injuries were treated over a period of 5 years. There were the same number of men and women and all patients were young (range: 7 to 35 years). The cause was illegal abortion in 2 cases and impalement following a fall from a tree in 3. The time lapse between injury and treatment was longer than 24 hours in 5 patients. In 2 cases the lesions were minor and simple debridement was possible. In the remaining 8 cases, construction of a colostomy was required using either the Hartmann terminal-type technique (n = 5) or the exclusion technique (n = 3). Three patients died: one from traumatic shock and two from septic shock. Complications were observed in 4 patients: 2 infections and 2 mechanical complications. Two patients presented permanent sequels including one with partial fecal incontinence. This study confirms the difficulty in management of ano-rectal injuries with limited facilities and reveals the variety of situations that can lead to these injuries especially in children in Africa.

[Typhoid perforations: experiences in a surgical setting in Cameroon. Apropos of 49 cases]. / Perforations typhiques: expérience en milieu chirurgical Camerounais. A propos de 49 cas.

Over a period of 3 years, 49 typhoid perforations of the small intestine were treated at Yaoundé Central Hospital. These 34 men and 15 women with a mean age of 29.6 years presented sthenic peritonitis in 20 cases and more difficult to diagnose asthenic peritonitis in 29 cases. The perforation was always located at the end of the ileum and was single in 40 cases, double in 6 cases and triple in 3 cases. Surgical management in association with intensive care and multiple agent antimicrobial therapy consisted in sleeve resection in 29 cases, resections with an exteriorized anastomosis in 15 cases, and ileocolonic intubation in 5 cases. The postoperative complications were suppuration of the wall (n = 4), intestinal fistula (n = 3), evisceration, and residual abscess. There were 9 deaths (18.4%) including 4 after sleeve resection and 5 after resection with an exteriorized anastomosis. On the basis of this experience, the authors describe the diagnostic difficulties posed by typhoid perforations, discuss surgical techniques proposed in the literature, and emphasize the value of sleeve resection.

Une demarche diagnostique des cancers du pancreas exocrine en milieu tropical

Il s'agit d'une etude sur 14 patients et visant a proposer a des malades a faible pouvoir d'achat une demarche diagnostique adaptee a un environnement sous-equipe en materiel et en personnel specialise. Les sequences clinique-echographie-cytoponction percutanee et clinique-echographie-laparotomie ont permis le diagnostic de 13 cancers du pancreas; ce diagnostic etait utilement complete par les donnees d'une laparotomie permettant un traitement palliatif sans aggravation du pronostic

[Diagnostic problems apropos of 2 clinical cases of lumbar Pott's disease]. / Problèmes diagnostiques à propos de deux cas cliniques de mal de POTT lombaire.

Two cases of POTT's disease without radiological osteoarticular destructions have been diagnosed from a psoas and a dorsal abscess. Bacteriology and histology were negative at the beginning, then became positive after a long evolution of the wound. The recommendation is to think of POTT's disease when confronted with any paravertebral abscess, with or without radiological signs and to repeat the bacteriological and histological tests if necessary.

[Malaria and post operative fever in the University Hospital Center of Yaounde (Cameroon)]. / Paludisme et fievre post-operatoire au Centre Hospitalier et Universitaire de Yaounde (Cameroun).

This study from a series of 80 patients showed that the prevalence rate of malaria increased from 8% before to 15% after surgery in the tropics. The difference was not significant (p < 0.05). The conclusion is that patients should be investigated for malaria parasites before any major surgery; in case of a non infectious post-operative fever, antimalarial drugs should be prescribed only to patients with a positive thick film.

Hernie discale lonbaire a Yaounde (Cameroun) : profil saccoradiculographique

A partir de 109 cas diagnostiques en 30 mois par saccoradiculographie (SR); les aspects radiologiques des hernies discales (HD) a Yaounde ont ete analyses afin d'etudier les potentialites de mise en route de techniques de radiologie interventionnelle. Le sex-ratio H/F des sujets etait de 1;3 et l'age moyen de 44 ans (etendue: 24-68). 78 pour cent des indications etaient une douleur de type sciatique avec forte suspicion clinique de hernie discale. Une atteinte de 2 disques a ete notee dans 20 pour cent des cas. 83 pour cent des hernies etaient medianes ou posterolaterales