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

[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.