RESUMO
INTRODUCTION: The aims of this study were to appreciate the epidemiological, therapeutic and pronostic aspects of breast cancer. This retrospective study was carried out in gynecology service in Hopital Principal of Dakar. We collected 473 cases of breast cancer over a period of 15 years, from January 1986 to December 2001. MATERIALS AND METHODS: Only the patients having a histological diagnosis were involued. The identification of patients, their medical history, their present complaints and the different treatment performed, were registred. The actuarial method of survival was used. RESULTS: The mean age of patients was 42.5 years; the average of parity was 4.7. The patients live in Dakar in 245 cases (51.7%). We had observed 279 cases (59.1%) diagnosed between six months and twelve months. Only 74 cases (15.8%) were diagnosed less than three months. In 282 cases (60%) the disease stage was T4N1Mx in TNM classification. In 425 cases (89.89) the histological type was infiltrate canal carcinoma. The surgery had concerned 441 patients (93.2%). And 52 of them (11%) underwent conservative treatment and 309 out of them (65.2%) underwent total mastectomy associated to axillary cleaning out like Patey method. Chemotherapy had been done in 426 cases (90%), hormonotherapy in 92 cases (19.4%) radiotherapy in 83 cases (17. 5%) and surgical costiation had been performed in 42 cases (8.8%). The overall survival at 15 years was (8.5%). CONCLUSION: According to the issues of other african series we found out that our patients were young at the time of the diagnosis, We think that early diagnosis and appropriated treatment must improve the prognosis of breast cancer. The mass screening politics must be involved.
Assuntos
Neoplasias da Mama/mortalidade , Neoplasias da Mama/terapia , Adulto , Idoso , Neoplasias da Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Senegal/epidemiologiaRESUMO
STUDY AIM: The aim of this study is to report 44 cases of male external genitalia cutaneous gangrene which have been observed at the Principal Hospital of Dakar (Senegal) during a 4-year period. PATIENTS AND METHODS: The patients all belonged to a black and poor population (mean age: 60 years). Diabetes was present in 11% of the patients. In ten patients, no aetiology was found. The other 34 cases were secondary mainly to urogenital pathology (50%). In 50% of the cases, the lesions were localised on the external genitalia, in the other 50%, the lesions had spread to the hypogastrium and/or the perineum. Medical treatment included intensive care and triple antibiotic therapy, penicillin, gentamycin and metronidazole. A hyperbaric oxygen therapy was associated in 25% of the cases. The surgical treatment in the acute period included incising, debridement, paring, draining, urinary derivation (n = 36), and colostomy (n = 5). Thirteen patients had the benefit of sequential and prospective bacteriological tests. RESULTS: Spontaneous healing was obtained in 48% of the patients within 2 to 3 months. Secondary reconstructive surgery consisted mainly in cutaneous grafts. Global mortality rate was 34%, mortality rate was 30% in the secondary gangrenes, 40% in the primitive gangrenes. Mean hospitalisation duration was 6 weeks. Main sequelae were cheiloïd scars. CONCLUSIONS: The authors try to clarify the nosological imprecisions of this pathology by distinguishing between the secondary types and the primitive types corresponding to Fournier's gangrene, which still inspires many questions concerning its etio-pathogenesis. The surgical treatment must eradicate all necrosis by suited iterative procedures, associated with local care. Hyperbaric oxygen therapy was not efficient in this series. This pathology, although rare, needs to be better known, because only an early and efficient surgical and medical treatment will be able to decrease the exceptional gravity of the prognosis.