[Value of vesical filling for umbilical cord prolapse. Description of a 14-case series at the Befelatanana University hospital center maternity unit (Antananarivo, Madagascar)]. / Intérêt du remplissage vésical au cours des procidences du cordon ombilical pulsatile. A propos de 14 cas observés à la maternité du CHUA de Befelatanana (Antananarivo-Madagascar).

Umbilical cord prolapse occurs when the umbilical cord drops through the open cervix into the vagina ahead of the baby, after spontaneous or artificial rupture of the membrane. It is a severe obstetrical emergency that endangers the life of the baby due to compression of the cord. Since the 1980s, bladder filling has been recommended as a simple and effective technique for reducing foetal mortality even if surgery cannot be undertaken immediately. The purpose of this study was to report experience using the bladder filling technique at the Gynaecology-Obstetrics Unit in Befelatanana (Antananarivo University Hospital Center). These results confirm the reliability and effectiveness as previously reported in the literature. Because of its simplicity and efficacy in reducing the risk for the foetus, bladder filling should be taught and used particularly in countries with limited obstetrical facilities.

[Hemoperitoneum caused by traumatic rupture of mesenteric lymphangioma cyst. Case report from Madagascar]. / Hémopéritoine par rupture post-traumatique d'un lymphangiome kystique mésentérique: à propos d'une observation à Madagascar.

Mesenteric cystic lymphangioma is an uncommon benign tumor. The purpose of this report is to present a case involving a 7-year-old girl who presented hemoperitoneum due to traumatic rupture of a mesenteric lymphangioma cyst. The patient who had a huge preexisting tumor mass presented with hemorrhagic shock symptoms following a severe fall. Peritoneum puncture lavage confirmed hemoperitoneum. Exploratory laparotomy revealed a large bleeding cyst-like mesenteric tumor. Total extirpation was difficult but successful. Histological examination of the surgical specimen demonstrated mesenteric lymphangioma. In developing countries like Madagascar, rupture of parasitic splenic cysts is the most frequent underlying etiology in children presenting hemorrhagic syndrome after falls. This case shows that mesenteric cystic lymphangioma rupture can be a rare cause.

[Neglected shoulders reported at the Befelatanana Maternity Hospital (Antananarivo, Madagascar)]. / Les épaules négligées vues à la maternité de Befelatanana à Antananarivo, Madagascar.

We conducted a retrospective study on neglected shoulders during 12 months at the Maternity Hospital of Befelatanana, 31 cases among 4685 deliveries were reported. The majority of the pregnancies are not under medical supervision and no ultrasound is carried out during the third trimester. There were 8 cases of uterine rupture, 2 haemorrhage shocks, 6 syndromes of prerupture, 6 umbilical cord prolapses at the third degree and 6 tears of the cervix. 20 caesarean sections have been performed as well as a turning of foetus in utero in 3 women, 4 hysterectomies, and a conservative suture with uterine tube ligation in the other cases. Often linked to a large multiparity the neglected shoulder remains quite frequent in developing countries such as Madagascar and regular prenatal consultations together with a rigorous clinical exam are highly recommended by the authors to make an early diagnosis and provide a better care management.

[Female genital tuberculosis: about 11 cases treated in Antananarivo (Madagascar)]. / La tuberculose génitale chez la femme: à propos de 11 cas suivis à Antananarivo, Madagascar.

A 5 year prospective study on genital tuberculosis, a rather uncommon localization, has been undertaken in 11 women treated at the DAT-HIS of Antananarivo, Madagascar Clinical diagnosis is problematic, if not unfeasible, due to the polymorphism of genital tuberculosis in women. Only histological and bacteriological examinations are, so far, confirmatory In the future, recourse to polymerase chain reaction will facilitate diagnosis and will allow a more accurate assessment of the incidence of this aspect of tuberculosis infection. Genital tuberculosis compromises women's fertility Even though the tuberculosis is cured, none of the 11 women of our research had carried their pregnancy to delivery, because artificial fertilization is not feasible here in Madagascar Screening of woman genital tuberculosis should be mandatory as regards gynaecological problems such as menstrual cycle disorders, sterility, abdominal pain, cyst of ovary ectopic pregnancy, spontaneous miscarriage in paraclinical investigations, especially in developing countries.

[Kidney cancer in horseshoe kidney. A case report of an unexpected diagnosis]. / Cancer sur rein en fer à cheval. A propos d'un cas de découverte fortuite.

The authors report a case of renal cell carcinoma in a horseshoe kidney and discuss diagnostic and therapeutical aspects arising from this combination. Renal carcinoid tumors and nephroblastoma seems to be more frequent in this malformation. Diagnosis of horseshoe kidney may be difficult and angiography examination is very useful to confirm renal anomaly, tumor situation, and to plan the surgical approach because vascularization vary case to case. Heminephrectomy adapted to neoplasic localisation remains the essential treatment.

[Unusual testicular tumor: an ectopic spleen]. / Tumeur testiculaire inhabituelle: une rate ectopique.

The authors report a case of discontinuous splenogonadal fusion diagnosed after left orchidectomy. Ectopic spleen in the scrotum is a rare congential anomaly frequently associated with other anomalies, especially limb defects. The diagnosis is difficult. Preoperative isotope scanning and intraoperative pathological examination can be performed to avoid unnecessary orchidectomy.

[Surgical treatment of neglected elbow dislocations. Report of 81 cases]. / Traitement chirurgical des luxations négligées du coude. A propos de 81 observations.

The neglected dislocations of the elbow are rare in Europe. In Africa, amongst 81 operated cases, during 10 years, 52 were seen again, with a follow-up between 4 months and 7 years. From this group, the authors are trying to define the place of open reductions and resections of the lower end of humerus. The surgical indications were set up in accordance with functional discomfort. The results of open reductions and those of resections were satisfactory, respectively in 72 per cent and 74 per cent of the cases in flexion-extension movement, and 31 per cent and 41 per cent in the pronosupination. The open reduction remains often possible, even after significant delay. The resections are more mutilating, and they involve risks of laxity. They should be reserved to immediate and late failures. The place of the prosthetic surgery in this ailment is not yet defined.

[Cutaneous malignant melanomas in New Caledonia. Study of the Cancer Registry (1977-1987)]. / Les mélanomes malins cutanés en Nouvelle-Calédonie. Etude du Registre des Cancers (1977-1987).

Investigation of cancer registration files in New Caledonia over a period of 11 years (1977-1987) draws the following conclusions: --The uncorrected incidence rate of cutaneous malignant melanoma is 3.63/100,000 inhabitants/year, for all ethnic groups together. --The incidence rate in the "non-European" population is 0.6/100,000 inhabitants/year. This low incidence and the anatomo-clinical manifestations observed (lentiginous melanoma of extremities) are common in coloured people. --The incidence rate in the "European" population is 8.75/100,000 inhabitants/year is noticeably higher than the incidence in the metropolitan population. Such conclusions are in accordance with the admitted data regarding epidemiology of cutaneous melanoma in high insolation countries. Cumulated incidence rate and topography of lesions are similar in this series whatever the sex.

[Vaginal hysterectomy: its place in surgical practice overseas as related to the experience of the Principal Hospital of Dakar]. / L'hystérectomie vaginale: sa place en pratique chirurgicale outre-mer à propos de l'expérience de l'Hôpital Principal de Dakar.

The authors report on their surgical practice of vaginal hysterectomy at the Principal Hospital of Dakar. First, they assign a place to the frequency of this technic. Then, they recall the major technical details, underlining advantages and limits. They conclude in favour of better knowledge and performing this technic more often, while recognizing some limits related to the pathologic context overseas.