[Internal iliac arteries ligation for intractable obstetrical hemorrhage in Africa]. / Ligature des artères iliaques internes face aux hémorragies obstétricales graves en milieu africain.

OBJECTIVES: Assess the efficiency of internal iliac arteries ligation in intractable obstetrical hemorrhage and ascertain success or failure factors. PATIENTS AND METHODS: It was a retrospective study which concerned 159 patients who underwent internal iliac arteries ligation for persistent and severe obstetrical hemorrhage from March 1992 to February 2007. Arrest of hemorrhage after ligation with survival of the patient was considered as successful; was considered as failure, persistence of hemorrhage in spite of the ligation or patient death. RESULTS: Internal iliac arteries ligation allowed hemorrhage control in 84.3% of cases. Main etiology of hemorrhage were: uterine atony (42.8%), abruptio placentae (31.4%). Coagulation disorders and hypovolemic shock, consequences of long delay of management were identified as bad prognosis factors. Blood transfusion was also singled out as a factor likely to ameliorate prognosis, especially in hemodynamic precarious situations. Surgical complications incidence was 1.89%, represented by two internal iliac vein lesions and one ureteral section successfully repaired. DISCUSSION AND CONCLUSION: Internal iliac arteries ligation is a prerequisite treatment of severe postpartum hemorrhage. The outcome is better when it is performed precociously (p=0.0000003) before the happening of disseminated intra vascular coagulation (p=0.006), hemodynamic troubles (p=0.0099) and acute severe anemia (p=0.02). It is a good alternative to arterial embolization in Africa.

[Craniopagus conjoined twins: difficulties of management in Africa]. / Jumeaux conjoints craniopages: difficultés de prise en charge en milieu africain.

Conjoined twins are the rare malformations of monozygotic-twins pregnancies associated with bad fetal prognosis. Craniopagus are even more rarely encountered and their management is complex particularly in our low-medical-equipment countries. From an observation of craniopagus twins, we present several difficulties in the management of the case. Diagnosis was late; because of the onset of labour, delivery was not prepared; the conditions of neonatal and social management were not adapted. Surgical treatment was not considered owing to the absence of appropriate technological conditions and means.

[A rare etiology of praevia barrier by the non gravid uterus in a duplex uterus (didelphys): ultrasound findings]. / Une étiologie rare d'obstacle praevia par l'utérus non gravide sur utérus double (didelphe): apport de l'échographie.

The Authors report a rare case of praevia barrier from a duplex uterus (didelphys). A 30 Year old pregnant woman was admitted for ultrasound examination. Her past history included two cesarean sections with a stillborn infant in one case and a live infant with psychomotor retardation in the other case. Third trimester ultrasound examination was consistent with a 36-37 weeks gestation. A 9.1 by 5.8 cm retro-cervical praevia mass was also noted deep in the pelvis. The mass was similar in appearance to myometrium. Elective cesarean section performed at 38 weeks of gestation delivered a normal healthy 2950 g male infant and revealed a second non gravid uterus corresponding to the mass seen at ultrasound. Pelvic examination confirmed a diagnosis of uterus didelphys (uterus duplex bicornis bicollis with vaginal septum) separated by a sagittal partition. The post-operative course was uneventful. Praevia barrier by a half uterus in a patient with duplex uterus is a rare condition that can easily be detected by careful ultrasound examination thus preventing complications at delivery.

[A rare etiology of abdominal calcifications: lithopedion]. / Une étiologie rare de calcifications abdominales: le lithopédion.

We report a case of a rare and particular cause of abdominal calcifications represented by the lithopedion. We describe different radiologic appearances observed by: abdominal plain film, echography and CT. It appeared to us that abdominal plain film alone is sufficient for diagnosis and undertaking surgery. Echography and CT are helpful, especially for complementary evaluation.

Monoclonal and oligoclonal gammopathies in heart-transplant recipients.

Immunoglobulin abnormalities in serum from 76 heart-transplant recipients were examined by cellulose acetate and agarose gel electrophoresis. Monoclonal components were typed by immunofixation. IgG, IgA, and IgM and total kappa and lambda light chains were quantified by immunonephelometry. We confirm that both monoclonal and oligoclonal immunoglobulin banding are common in serum from these patients. Of the 149 serum samples examined, 21 (15%) had one monoclonal component and 53 (35%) had two or more. These monoclonal immunoglobulins were generally present at a low concentration and were transient. The class of immunoglobulins most commonly involved was IgG (about sevenfold more numerous than IgM); monoclonal IgA components and free light chains were not detected. The nephelometric kappa/lambda and heavy chain/light chain ratios were poor indicators of these abnormalities. Immunoglobulin abnormalities were not correlated with the sex and age of recipients, the pre-existing cardiopathy, the time since transplantation, or plasma concentrations of cyclosporine, but did correlate with plasma immunoglobulin concentration, biopsy findings, and viral infections, especially cytomegalovirus (CMV). A monoclonal IgG purified from a patient with a high titer of anti-CMV antibodies did not react with CMV antigens. The origin of these immunoglobulin abnormalities is unclear. Our data suggest that the presence of monoclonal or oligoclonal banding in heart-transplant recipients is of limited prognostic significance.