Superior vena cava tumoral thrombosis revealing a Burkitt's lymphoma and a lymphoblastic non-Hodgkin's lymphoma. A case report.

Superior vena cava thrombosis (SVCT) is a rare pathology, though of great significance since it implies the development of a malignant process. The most common etiologies are basically bronchopulmonary and mediastinal tumors. Observations involving 2 patients presenting with superior vena cava syndrome (SVCS) are reported in this study, in which radiologic investigations (chest roentgenogram, computed tomography scan of the thorax, and superior vena cavography) revealed thrombosis of the SVC disclosing in both cases a non-Hodgkin's lymphoma. The first case was a mediastinal Burkitt's lymphoma in a thirty-eight-year-old man (exceptional form) and in the second case a lymphoblastic non-Hodgkin's lymphoma in a nine-year-old girl. In the patient with Burkitt's lymphoma healing was satisfactory twenty-four months after treatment by surgery, chemotherapy, and radiotherapy. The second patient died suddenly. In both cases the SVCT revealed the tumor. The causes of SVCT are reviewed and discussed.

[Cerebral malaria in the child. A study of 11 cases with good prognosis at CHU of Yaoundé, Cameroon]. / Le paludisme cérébral de l'enfant. Une étude de 11 cas de bon pronostic au CHU de Yaoundé, Cameroun.

From January to December 1993, 11 cases of cerebral malaria out of a total of 106 cases of malaria were admitted in the paediatric unit of the Yaounde University Teaching Hospital. These 11 patients were comprised of 6 boys and 5 girls aged 6 months to 10 years with a mean of 4.24 years. Convulsions and coma were the main clinical manifestation in 9 and 11 patients respectively. 10 patients had fever with 1 case of hyperpyrexia, whereas splenomegaly was noted in 6 patients and hepatomegaly in 2. Parasitemia was between 0.02 and 4 %. Chemoprophylaxis was irregular in 2 patients and absent in 9. The average hospital stay was 5.5 days and no death was noted in our series.

The clinical spectrum of severe malaria in children in the east provincial hospital of Bertoua, Cameroon.

Severe malaria claims 1.5 to 2.7 million lives annually most of which are young children in rural areas in sub-Saharan Africa. We retrospectively reviewed the files of 387 patients, admitted and treated for severe malaria according to WHO guidelines, in the Bertoua provincial hospital, a peripheral health center in East Cameroon from 1st October 1998 to 30h October 2000. Our main objective was to study the epidemiological aspects, clinical presentation and outcome. The mean age was 2.7 years (range 2 months - 15 years) among them 214 males and 173 females giving a sex ratio of 1.2. Transmission was observed all year round at variable frequencies with peaks in the rainy seasons. Major symptoms were fever in 202 patients (52.2%), convulsions in 150 (38.8%), prostration in 79 (20.4%) and persistent vomiting in 78 patients (20.2%). Major clinical findings were severe pallor in 196 patients (50.6%) and splenomegaly in 75 patients (19.4%). The average time between onset of symptoms and consultation was 4.4 days (range 1 - 21 days). Blood smears were positive for Plasmodium falciparum in 288 patients (74.4%) and negative in 99 (25.6%). Concerning outcome, recovery was observed in 317 patients (81.9%), interruption of treatment (because of financial constraints) in 58 (15%) and 12 deaths (3.8%). Among the 317 patients who recovered, neurological sequelae were observed in six patients, blindness in four patients and deafness in three patients were the most frequent. We conclude that severe malaria constitutes a major challenge of early diagnosis together with implementation of appropriate treatment especially in rural areas. The use of WHO guidelines in the management of this disease and the recommended preventive measures of vector control have yielded good results in patients managed and followed up in our hospital.

[Neonatal septicemia and meningitis caused by gram-negative bacilli in Yaondé: clinical, bacteriological and prognostic aspects]. / Les septicémies et méningites néonatales a bacilles gram négatifs a Yaoundé: aspects cliniques, bactériologiques et pronostiques.

Based on 139 cases collected in 36 months, the authors show that neonatal sepsis and meningitis with Gram negative bacilli represent 62.33% of confirmed neonatal sepsis (223 cases out of 6,784 neonatal hospitalisations). 53.96% of cases are manifest within the first 72 hours of life. 35.25% of these infants are preemies. The principal predisposing factors are: foul-smelling leukorrhea (45.23%), prolonged rupture of membranes (26.62%) and notion of resuscitation (36.69%). The most important clinical signs are: thermal dysregulation (47.48%), tonus disturbances (35.97%) and respiratory distress (25.90%). Sepsis make up 85.61% of cases; the principal germs isolated being: Acinetobacter (21.58%), Pseudomonas (15.83%), Escherichia coli (14.39%), Enterobacter (12.95%), Klebsiella (11.51%). Of the germs isolated, 27.78% were resistant to initial treatment with the association ampicillin gentamicin. Mortality rate was 46.76%.

[Severe forms of malaria in children in a general hospital pediatric department in Yaounde, Cameroon]. / Les formes graves du paludisme de l'enfant dans un service de pédiatrie générale à Yaoundé, Cameroun.

Severe forms of malaria in children are responsible for 1 million deaths yearly in young children in hyperendemic areas. The main objective of this study was to identify and compare common manifestations of different forms of severe malaria and to evaluate the prognosis for hospital treatment in an endemic area. 271 files of children admitted into hospital between March 1991 and September 1996 were analysed. These children were confirmed to have Plasmodium falciparum in their peripheral blood. 78 patients (29%) had the severe form of malaria. 43 patients (53%) were under 5 years of age. The 5 severe types identified were characterized by very high temperatures 28 cases (36%), cerebral malaria 20 cases (26%), prostration and weakness 15 cases (19%), severe anaemia 14 cases (18%) and haemoglobinuria 1 case (1.3%). Cerebral malaria and severe anaemia were more common in children under 5 years old. The average parasitemia was 16,366 +/- 1390 parasites per microlitre. Clearance of parasitemia was obtained on day 3 in almost all cases; 6 patients with very high temperatures presented neither sign of visceral complications nor convulsions. The average period in coma for cases of cerebral malaria was 1.7 days; 12 anaemic patients were transfused. There were no deaths. No abnormality was found on physical examination after an average hospitalisation of 5.3 days. An early diagnosis and adequate treatment of severe forms of malaria in children by qualified personnel will usually result in a favourable prognosis in our area.

[Solitary extra-osseous ovarian plasmacytoma. Apropos of an unusual case in a 12 year old child]. / Le plasmocytome solitaire extraosseux ovarien. A propos d'un cas exceptionnel chez une enfant de 12 ans.

A rare case of extramedullary or solitary ovarian plasmocytoma in a 12 years old patient is reported. Surgery consisted of left adnexectomy associated with omentectomy. Chemotherapy with abdomino-pelvic iradiation were effectuated afterwards. Review of literature and therapeutic indications are discussed.

[Postoperative necrotizing fasciitis in infants. Apropos of a case]. / Fasciite nécrosante post-opératoire chez le nourrisson. A propos d'un cas.

A case of postoperative necrotizing fasciitis after a right incarcerated inguinal hernia repair is reported in a six week old baby hospitalized in the paediatric surgical unit of the Yaounde General Hospital. Treatment consisted in a medical reanimation, surgical debridement and an appropriate antibiotherapy. Medical literature was reviewed and therapeutic indications discussed.

[Cerebral malaria in children in Cameroon. Apropos of 11 cases]. / Neuropaludisme de l'enfant au Cameroun. A propos de 11 cas.

Eleven cases of cerebral malaria were observed among 106 hospitalized malarian children. A brief recall of pathophysiology is given, including its immunological aspect. Symptomatology and course of this severe form are evoked. All children were treated by IV then oral quinine and recovered without any neurological sequelae. The importance of a very early treatment is strongly emphasized.

[Factors associated with the survival of very low birth weight neonates at the Yaounde gynaeco-obstetric and pediatric hospital, Cameroon]. / Facteurs associés à la survie des nouveau-nés de très faible poids de naissance à l'hôpital gynéco-obstétrique et pédiatrique de Yaoundé, Cameroun.

OBJECTIVES: The rate of survival of very low birth weight neonates (less than 1500 g) is still low in most developing countries, such as Cameroon. The aim of this study was to assess the maternal and neonatal factors that can influence the survival of neonates with birth weights under 1500 g. MATERIAL AND METHODS: This was a retrospective, descriptive, and analytic study of 397 neonates weighing less than 1500 g who were admitted to the Yaounde gynaeco-obstetric and pediatric hospital from May 2003 to December 2011. The chi-squared test and the odds ratio were used to identify risk factors for death. The threshold of significance was P<0.05. RESULTS: The overall survival rate was 26.5%. The main comorbidities were prematurity (99%), neonatal sepsis (36%), and intrauterine growth retardation (27.2%). The factors that statistically influenced outcome were: parity, birth weight, gestational age, the 5th-min Apgar score, advanced resuscitation at birth, and respiratory distress. CONCLUSION: The survival of neonates weighing less than 1500 g depends on several factors, which if acted upon could improve the survival rate.

Neonatal mortality in a referral hospital in Cameroon over a seven year period: trends, associated factors and causes.

BACKGROUND: The fourth Millennium Development Goals targets reduction of the mortality rate of under-fives by 2/3 by the year 2015. This reduction starts with that of neonatal mortality representing 40% of childhood mortality. In Cameroon neonatal mortality was 31% in 2011. OBJECTIVES: We assessed the trends, associated factors and causes of neonatal deaths at the Yaounde Gynaeco-Obstetric and Pediatric Hospital. METHODS: The study was a retrospective chart review. Data was collected from the hospital records, and included both maternal and neonatal variables from 1(st) January 2004 to 31(st) December 2010. RESULTS: The neonatal mortality was 10%. Out-borns represented 49.3% of the deceased neonates with 11.3% born at home. The neonatal mortality rate followed a downward trend dropping from 12.4% in 2004 to 7.2% in 2010. The major causes of deaths were: neonatal sepsis (37.85%), prematurity (31.26%), birth asphyxia (16%), and congenital malformations (10.54%). Most (74.2%) of the deaths occurred within the first week with 35% occurring within 24 hours of life. Mortality was higher in neonates with birth weight less than 2500 g and a gestational age of less than 37 weeks. In the mothers, it was high in single parenthood, primiparous and in housewives and students.. CONCLUSION: There has been a steady decline of neonatal mortality since 2004. Neonatal sepsis, prematurity, birth asphyxia and congenital malformations were the major causes of neonatal deaths. Neonatal sepsis remained constant although at lower rates over the study period.

[Clinical and etiological aspects of focal epilepsy in children at Yaoundé Gynaeco-obstetric Hospital (Cameroon)]. / Aspects cliniques et etiologiques de l'epilepsie focale de l'enfant a l'hopital Gyneco-obstetrique et pediatrique de Yaounde (Cameroun).

OBJECTIVE: To describe the clinical and etiological aspects of child focal epilepsy at Yaoundé Gynaeco-Obstetric and Pediatric Hospital (YGOPH) in Cameroon. PATIENTS AND METHODS: It was a cross-sectional descriptive study carried out in pediatric neurology and epileptology unit of YGOPH from October 1st 2011 to March 30th 2012. We included 218 patients aged 0-16 years with a diagnosis of focal epilepsy in whom an electroencephalogram (EEG) was performed. The studied variables were epidemiological, etiological factors, type of epilepsy, EEG abnormalities, abnormalities in brain CT-scan, and probable etiology. RESULTS: The sex ratio was 1.34 M/1F. The mean age of patients was 8 ± 4 years. In 58.71% (128/218) the onset of crises was before the age of five and decreased gradually until adolescence. The EEG showed an epileptic focus in 161 patients (73.85%). The main foci were centro-temporal (19.9%), frontal (19.2%), temporal (14.9%) and fronto-temporal (14.9%). The CT-scan was abnormal in 58 (56.86%) of 102 patients, who performed head CT-scan, with as major abnormalities, brain atrophy and after-effects lesions. Etiological factors were found in 76.15 % of patients, it was mainly neonatal asphyxia (21%), family history of epilepsy (20.6%) and febrile seizures (19.7%). Focal epilepsies were of structural (51.4%), genetic (24.3%) or unknown causes. Neurological abnormalities associated were more frequently in focal epilepsies of structural causes. CONCLUSION: The focal child epilepsies are mostly of structural causes and preferentially temporal and/or frontal in location. The main etiological factors are family history of epilepsy and neonatal asphyxia.

OBJECTIF: Décrire les caractéristiques cliniques et étiologiques de l'épilepsie focale de l'enfant à l'Hôpital Gynéco-obstétrique et pédiatrique de Yaoundé (HGOPY) au Cameroun. PATIENTS ET MÉTHODE: Il s'agissait d'une étude transversale descriptive réalisée dans l'unité de neuropédiatrie et d'épileptologie de HGOPY du 1er octobre 2011 au 30 mars 2012. Elle incluait 218 patients âgés de 0 à 16 ans ayant un diagnostic d'épilepsie focale et chez qui un électroencéphalogramme (EEG) avait été réalisé. Les variables étudiées étaient les données épidémiologiques, les facteurs étiologiques, le type d'épilepsie, les anomalies EEG, les anomalies au scanner cérébral, et l'étiologie probable. RÉSULTATS: Le sex-ratio était de 1,34M/1F. L'âge moyen des patients était de 8 ± 4 ans. Les crises débutaient dans 58,71% (128/218) avant l'âge de cinq ans et diminuaient progressivement jusqu'à l'adolescence. L'EEG révélait un foyer épileptique chez 161 patients (73,85%). Les principaux foyers étaient centro-temporal (19,9%), frontal (19,2%), temporal (14,9%) et fronto-temporal (14,9%). Le scanner était pathologique chez 58 (56,86%) des 102 patients ayant fait le scanner cérébral, avec pour principales anomalies l'atrophie cérébrale et les lésions séquellaires. Les facteurs étiologiques étaient retrouvés chez 76,15% des patients; ils s'agissaient principalement de l'asphyxie néonatale (21%), des antécédents familiaux d'épilepsie (20,6%) et des convulsions fébriles (19,7%). Les épilepsies focales étaient de causes structurelles (51,4%), génétiques (24,3%) ou inconnue. Les anomalies neurologiques associées étaient plus fréquentes dans les épilepsies focales de cause structurelle. CONCLUSION: Les épilepsies focales de l'enfant sont en majorité structurelles et préférentiellement temporales et/ou frontales. Les principaux facteurs étiologiques sont les antécédents familiaux d'épilepsie et l'asphyxie néonatale..

[Clinical, etiological, and therapeutic aspects of febrile convulsions. A review of 325 cases in Yaoundé]. / Aspects cliniques, étiologiques et thérapeutiques des convulsions fébriles. A propos de 325 cas à Yaoundé.

A prospective study of 325 children with febrile seizures was conducted in 2 hospitals in Yaoundé, from 15 January to 15 December 2008. The proportion of patients with febrile seizures among all admitted patients was 6.1%. The mean age was 24.6 months; the peak age of these patients was 12-17 months. The sex ratio was 1.5. The mean temperature on admission was 39.2 degrees C. There was a family history of febrile seizures in 36.4%. Simple febrile seizures were seen in 58.7% and the complex type in 41.3%. Malaria was the main etiology in 67.7%, followed by upper and lower respiratory tract infection in 14.1% and 9.8%, respectively. Lumbar puncture was performed in all patients. The commonest anticonvulsant used to stop seizures was rectal diazepam in 88%. Febrile seizure prophylaxis was administered to 43% of the patients; antipyretics were the most widely used, either alone or combined with rectal diazepam.

Anthropometric measurements of children attending a vaccination clinic in Yaounde, Cameroon.

BACKGROUND: Growth faltering is a frequent public health problem in children and anthropometric measurements are useful tools for follow-up and early diagnosis. This problem has not been studied in the Cameroonian setting, that's why we undertook this study. OBJECTIVES: To have a synopsis of the nutritional status in apparently healthy children attending a vaccination clinic and show the importance of anthropometric measurements in routine child health care. DESIGN: A retrospective study. PATIENTS AND PARTICIPANTS: 1351 children aged (6-24 months), who attended the vaccination clinic of the Yaounde Gynaeco-Obstetric and Pediatric Hospital over a 6 month period, were enrolled in the study. METHOD: The registers of the vaccination clinic of the above hospital were retrospectively reviewed from 1st March to 31st August 2005. The following parameters were noted: age, height, weight, mid-upper arm circumference (MUAC), and Z scores calculated for the following indicators: weight for age (WAZ), weight for height (WHZ), and height for age (HAZ). RESULTS: Our results show that 12 children (1.1 percent) in the 0-6 months age group and 4 (1.6 percent) in the 6-12 months age group had WAZ less than -2 indicating underweight. Also 10 children (0.9 percent) and 2 (0.8 percent) in the 0-6 and 6-12 months age groups respectively had WHZ less than -2, indicating wasting. HAZ was less than -2 in 70 children (6.4 percent) and in 8 (3.2 percent) in the 0-6 and 6-12 months age groups respectively indicating stunting. The MUAC was less than 12.5 cm in 6 children (2.4 percent). CONCLUSIONS: From our results, we conclude that growth faltering is common in supposedly healthy children attending our vaccination clinic. Anthropometric measurements are thus recommended and should be encouraged in routine child care settings for early diagnosis of growth retardation and to provide useful interventions.

Isolated congenital fusion of the gums.

Isolated congenital fusion of the gums is a rare anomaly. Early surgical treatment is indicated, as longstanding cases will impair normal feeding leading to nutritional and growth problems. We report the first case in the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, which was successfully managed surgically.

[Variola or a severe case of varicella? A case of human variola due to monkeypox virus in a child from the Cameroon]. / Variole ou varicelle grave? Un cas de variole humaine à monkeypox virus chez un enfant Camerounais.

Human monkeypox was suspected on clinical grounds in a seven years old child in Cameroon. The diagnosis was confirmed at the Center for Disease Control (CDC) in Atlanta, USA. This condition is rare. The present case is the third in Cameroon. An epidemiological and clinical survey carried out in the family and in the area where the patient lives, did not allow to identify other cases. The clinical evolution of the case was good as in those described elsewhere.

Initial treatment of bacterial meningitis in Yaounde, Cameroon: theoretical benefits of the ampicillin-chloramphenicol combination versus chloramphenicol alone.

A prospective 6-month study in Yaounde evaluated 49 children aged from 2 months to 8 years, hospitalized with bacterial meningitis. They were randomly assigned to one of two initial treatment groups, either an ampicillin-chloramphenicol combination (group A) or chloramphenicol alone (group B). The majority of patients were infected with Haemophilus influenzae, and the majority of deaths were caused by Streptococcus pneumoniae. Altogether, 17.9% of Haemophilus influenzae isolates were ampicillin-resistant and 3.6% chloramphenicol-resistant. We found no isolate resistant to both antibiotics. Response to both treatments was similar in both groups. The theoretical risk of treatment failure with ampicillin was higher than with the ampicillin-chloramphenicol combination (p less than 0.05). There was no statistically significant difference between the risk of treatment failure with the ampicillin-chloramphenicol combination and the risk with chloramphenicol alone (p less than 0.05), but the latter was increased by the occurrence of chloramphenicol-resistant isolates of Streptococcus pneumoniae (11.1%). Although treatment with an ampicillin-chloramphenicol combination is four times more expensive than treatment with chloramphenicol alone, costwise it is also one-quarter the price of a third-generation cephalosporin (moxalactam). At present, the ampicillin-chloramphenicol combination can be suggested as the first choice for initial treatment considering both the epidemiological data and the cost/efficiency ratio in the area of Yaounde.

[Neonatal streptococcus group B infection in Yaoundé (Cameroon). Epidemiologic and clinical aspects]. / Infection néonatale à streptocoque du groupe B à Yaoundé (Cameroun). Aspects épidémiologiques et cliniques.

This study was designed to investigate epidemiologic and clinical features of neonatal group B streptococcal infections. Sixty cases seen over a 60-month period were reviewed. Incidence was 0.8% of admissions. Most affected infants were from low-income families (86.7% of mothers were unemployed and 73.5% of homes were without running water). Neonatal infection was delayed in most instances (76.67%). Fetid vaginal discharge (60%) and premature rupture of the membranes (35%) were the main findings upon history taking. Abnormal body temperature regulation (76.7%) was the most prominent clinical manifestation. Respiratory distress developed in 25% of patients. Meningeal involvement occurred in 73.3% of patients. Serotype B III was recovered in 31 of the 34 cases (91%) in which serotype was determined. Mortality rate was 21.7% and permanent sequelae occurred in 8.3% of patients.

[Cerebral malaria in children in Yaounde, Cameroon. Clinical, paraclinical and developmental aspects]. / Le neuro-paludisme de l'enfant à Yaoundé, Cameroun. Aspects cliniques, paracliniques et évolutifs.

Cerebral malaria is one of the major and deadly complications of malaria. In Cameroon, recent reports indicate that severe cases of malaria are increasingly more prevalent, particularly in children. The present study aims at describing the clinical presentation and laboratory findings of cerebral malaria in children in Yaounde. All patients admitted in the paediatric ward of Yaounde Central Hospital with malaria, who presented neurological signs and were tested positive for Plasmodium in their peripheral blood were recruited into the study. 36 cases were enrolled in all, making up 2.7% of all admissions. The patients' median age was 4.5 years. 52.8% were on malaria prophylaxis. Convulsions and coma with preceding hyperthermia were present in more than 90% of the patients. Blood parasites level median was 1.3% on admission. One patient had hypoglycaemia on admission and two others had it later on after admission; 16.7% had neurological sequels at discharge and two children died (5.6%). Delay in diagnosis and initiation of treatment with quinine adversely affected the prognosis of cerebral malaria in the study group.