[Can venous iron and tranexamic acid reduce the transfusion need? Report on a non randomized, case control study]. / L'association fer intraveineux et acide tranexamique permet-elle de réduire le besoin transfusionnel ? Une étude comparative non randomisée.

OBJECTIVES: To evaluate if the association of injectable iron and tranexamic acid allows a significant saving in transfusion, in cases of myomectomies and hysterectomies. PATIENTS AND METHOD: This is a prospective, non randomized study done over 8 months (from January 2013 to August 2013). Were included, patients undergoing hysterectomy or myomectomy who had a hemoglobin level greater than or equal to 8g/dl and less than 12g/dl. Two groups were compared: group A consisting of patients for whom a pack red cells was ordered and the group B which patients received intravenous iron preoperatively and tranexamic acid perioperatively. The level of hemoglobin, pre- and postoperative, the average number of blood units per patient and estimated blood loss was compared. The transfusion economy was evaluated. RESULTS: During this period, 87 patients with a mean age of 40±9 years (range: 23 and 70years) were included according to our criteria: 44 patients in group A and 43 patients in group B. Initial mean hemoglobin in both groups was 9.1±0.7g/dl. In group B, after iron administration, the mean hemoglobin was 11.3±0.7g/dl. The average number of red blood cells received intraoperative patient in group A was 1.54±0.51. The estimated blood loss was significant greater (P=0.0002) in group A (571.6±237.1ml) than in group B (213.7±131.7ml). No transfusion was performed in group B. CONCLUSION: The association intravenous iron and tranexamic acid resulted in the reduction of transfusion requirements in our setting. It could be integrated in the strategy for sparing blood transfusion in scheduled surgery with hemorrhagic risks.

[Abdominal pregnancy in Libreville from 1999 to 2009]. / Grossesse abdominale à Libreville de 1999 à 2009.

INTRODUCTION: Abdominal pregnancy (AP) is defined as the implantation and development of the fertilised egg in the cavity of peritoneum. It causes severe perinatal morbity and mortality. OBJECTIVE: Underline the epidemiologic, diagnostic, therapeutic and prognostic aspects of the AP. METHODOLOGY: Retrospective study conducted at Maternité Joséphine Bongo (maternity hospital) and at the Centre Hospitalier de Libreville (hospital centre) from January 1999 to December 2009 on 19 cases of abdominal pregnancies. RESULTS: The frequency of AP in Libreville is one per 4447 deliveries (0.2 ‰) and one per 141 tubal ectopic pregnancies (0.7%). The mean age was 30.5 ± 7.2 years old and the mean parity 2.7 ± 1.7. The mean term of occurrence was 24.3 weeks of amenorrhoea (WA) with extremes at 14 and 39 WA. The diagnosis was made in the face of abdominal and pelvic pains in all the patients and an amenorrhoea in 11 cases (57%). It was confirmed by ultrasound scan in 14 cases (73.7%) and further to a laparotomy in five (26.3%) patients. We had two live births at 39 and 38 WA with respective birth weights of 2,380 and 2,550 g. Expulsion of the placenta was complete in seven (36.8%) cases. Five (26.3%) patients experienced hemorrhagic complications. CONCLUSION: AP is a rare pathology. Its diagnosis beyond of the second quarter is difficult with an often-pejorative foetal forecast.

[Does tropical environment influence morbidity and mortality?]. / Le contexte tropical influence t-il la morbidite et la mortalite?

Despite enormous progress in medical science, health care coverage in poor countries remains incomplete, uncertain and minimal. The probability of death is higher in Africa. Life expectancy is only from 50 to 55 on the African continent in comparison with over 70 years in North America and Europe. The African population is predominantly young but malnutrition, deficiencies, anemia, parasitism and genetic defects (drepanocytemia) are widespread. In general treatment of acute trauma and illness is straightforward and vital or functional prognosis is good provided that proper elementary care is administered rapidly. However due to difficult field conditions and limited medical facilities, care is often delayed. Most patients are admitted with advanced, complicated disease to facilities that are often poorly equipped, undersupplied and lacking in qualified personnel, basic medication and blood products. This combination of factors accounts in part for the fact that prognosis of the same disease is poorer in tropical areas than in other areas of the world. Rational use of human resources and better organization of international cooperation would allow short-term improvement in health care in tropical areas. It is only at this price that people in the Northern and Southern hemisphere in this time of globalization can have the same chance of survival for the same disease.