[HELLP syndrome: nine cases treated at Josephine-Bongo Maternity Hospital]. / Le HELLP syndrome : à propos de neuf cas traités à la maternité Joséphine-Bongo.

INTRODUCTION: the aim of this study was to evaluate the management of HELLP syndrome at Josephine-Bongo Maternity Hospital. STUDY POPULATION AND METHODS: the retrospective study included all women admitted to the intensive care unit of our hospital from 1 January 2004 through 30 December 2007 with HELLP syndrome. The characteristics studied included: age, parity, number of previous pregnancies, antenatal monitoring, term at onset, clinical and laboratory signs, treatment, complications, perinatal and neonatal mortality and duration of intensive care unit admission. RESULTS: nine patients, mainly primiparas with an average age of 29.7 ±â€Š6.5 years were admitted to intensive care. HELLP syndrome was diagnosed at a mean term of 33 ±â€Š2.7 weeks. The clinical signs noted included the following: jaundice (100%), headaches (100%) and epigastric pain (67%). The laboratory analysis showed: a mean haemoglobin level of 8.7 ±â€Š1.2 g/dL, an average platelet level of 70,900 ±â€Š27,052.9/mm(3), and mean transaminase levels of 120 ±â€Š60 UI/L for aspartate aminotransferase (AST) and 99 ±â€Š41.1 UI/L for alanine aminotransferase (ALT). Hypertension was treated by continuous intravenous administration of nicardipine. The fetal pulmonary development was ensured with betamethasone. Delivery was by caesarean for four women (44%) and vaginal for the other five (56%). One maternal death was noted, related to a rupture of a subcapsular haematoma of liver. CONCLUSION: in view of the extent of perinatal morbidity and mortality associated with HELLP syndrome, abdominal ultrasonography to detect any subcapsular haematoma of liver should be performed to determine the need for immediate delivery. It would be appropriate to provide the Josephine-Bongo Maternity Hospital with a neonatal intensive care unit of high quality.

[Diffuse cervico-facial cellulitis: 32 cases in Libreville]. / Cellulites cervico-faciales diffuses: 32 cas vus à Libreville.

OBJECTIVE: The aim of this study was to analyze the predisposing factors and the diagnostic and therapeutic aspects of diffuse cervico-facial cellulitis. MATERIAL AND METHODS: This retrospective study examined the records of all 32 patients admitted to the ENT and cervico-facial department of the Omar Bongo Ondimba Army Teaching Hospital in Libreville with diffuse cervico-facial cellulitis, from January 2006 through December 2010. RESULTS: The study included 18 women (56%) and 14 men (44%) with a mean age of 28 years. At admission, 28 patients (87.5%) had already received anti-inflammatory drugs and 25 (78%) one or more antibiotics. Two patients were HIV+. The main route was dental for 21 patients (66%), tonsillar for 4 (13%), submandibular for 2 (6%), parotid for 2 cases (6%), cutaneous for 1 (3%) and unspecified in 2 more (6%). The cellulitis was pseudo-phlegmonous in 24 patients (75%) and gangrenous in 8 cases (25%). It extended to the mediastinum in six patients (19%). The bacteriological study, carried out in 24 cases (75%), found 14 cases of aerobic germs. Medical or medical and surgical treatment led to cure for 30 patients (94%). Two patients (6%) died. CONCLUSION: Treatment of cervico-facial cellulitis must be early and multidisciplinary. Self-medication with anti-inflammatory drugs for bucco-pharyngeal infections without appropriate antibiotic treatment is the principal predisposing factor.

[Cranioencephalic complications of bacterial sinusitis in children and adolescents: eight cases in Libreville (Gabon)]. / Complications cranioencéphaliques des sinusites bactériennes chez l'enfant et l'adolescent: étude de huit cas vus à Libreville (Gabon).

OBJECTIVE: To review the pathologic, diagnostic and therapeutic aspects of the cranioencephalic complications of bacterial sinusitis. MATERIAL AND METHODS: This retrospective study included children who underwent diagnostic imaging at the Omar Bongo Ondimba military hospital between January 2006 and December 2010 and treatment of cranioencephalic complications of sinusitis. RESULTS: During the study period, 58 children were hospitalized with sinusitis, and eight (13.8%) had cranioencephalic complications for an annual incidence of 1.6% and a sex ratio of 5 boys to 3 girls. Their mean age was 13 years. Symptoms developed over a mean duration of 14 days (range: 3-45 days). The clinical picture was dominated by febrile headaches and neurologic signs. Palpation of the sinus pressure points was painful in all cases. Disorders of consciousness were found in five cases, with a mean Glasgow score of 9 (range: 7-13). Seven children had multifocal sinusitis and one frontal sinusitis. Five children had a subdural empyema, two associated with thrombophlebitis of the sagittal sinus, one with a brain abscess with thrombophlebitis of the sagittal sinus, and another with meningitis and thrombophlebitis of the sagittal sinus. Two children had osteomyelitis of the frontal sinus table, including a frontal lobe abscess for one. Another had multiple cerebral abscesses. Five children had sinus and neurosurgical drainage, two sinus drainage only, and one neurosurgical drainage only. Microbiology was positive for microbes in four cases: Streptococcus eqinus (one case), Staphylococcus aureus (one case), both S. pneumoniae and Haemophilus influenzae (one case), and Aerococcus viridans (one case). Outcome was favourable in seven cases, including four without sequelae. Two children had recurrences, and one died. CONCLUSION: Diagnosis of the cranioencephalic complications of sinusitis rely on medical imagery. Early multidisciplinary therapeutic management is essential.