La prise en charge de l'ectopie testiculaire a l'hopital central de Yaounde : a propos de 171 cas

INTRODUCTION:L'ectopie testiculaire est frequente. Le diagnostic et la prise en charge precoces sont necessaires a cause des risques d'atrophie; de cancerisation; de subfertilite; et les consequences psychologiques en rapport avec l'absence d'un testicule dans une bourse. Cette prise en charge est tardive dans notre milieu. Le but de ce travail etait d'etudier les facteurs interferant avec cette prise en charge. MeTHODOLOGIE Nous avons revu 172 dossiers des patients operes d'ectopie testiculaire de 1999 a 2012. Nous avons etudie l'age au moment de l'operation; la qualification de la personne ayant assure l'accouchement; les facteurs interferant avec la prise en charge et les resultats de cette prise en charge. ReSULTATS L'age des patients au moment de la chirurgie variait de 1 a 48 ans; avec une moyenne de 8 ans. Seuls 21 patients avaient ete operes dans les delais recommandes. L'information medicale avait ete erronee ou insuffisante dans 93 cas. L'on retrouvait la peur de l'operation dans 42 cas; les problemes financiers dans 14 cas; l'ignorance des parents dans 7 cas. CONCLUSION Le manque d'information des soignants ou des parents; la peur de l'operation et le manque de moyens financiers sont les principales causes de delai dans la prise en charge de l'ectopie testiculaire. Ce travail fait ressortir la responsabilite du personnel de sante dans le la prise en charge precoce de l'ectopie testiculaire

Le monitorage respiratoire per operatoire chez l'adulte

Le monitorage respiratoire est necessaire au cours de l'anesthesie car les agents anesthesiques depriment la ventilation. Il donc faut assurer une suppleance et la surveiller. Le monitorage n'exclut pas la surveillance clinique du patient par un personnel anesthesique present attentif en salle d'operation. Il est base sur l'oxymetrie de pouls; la capnographie; les parametres ventilatoires; les concentrations des gaz anesthesiques et les alarmes

[Traumatic jejuno-ileal ruptures: apropos of 18 cases at the Central Hospital of Yaounde]. / Les ruptures traumatiques jéjuno-iléales: àpropos de dix huit (18) observations àl'hôpital Central de Yaoundé

Eighteen blunt small bowel traumas were reviewed in this retrospective study (1986-1996) concerning 12.8% of laparotomies for blunt abdominal trauma. The clinical presentation at admission was peritonitis (9 cases) or hemoperitoneum (4 cases) whereas 5 cases were diagnosed lately because of non specific signs at the beginning. All patients underwent surgery: simple suture or suture after excision of edges (12 cases); resection anastomosis (6 cases). There were no post-operative complications in most of the cases. The mortality rate was 5%. Blunt small bowel traumas are not frequent in our practice. Their diagnostic is often per-operative. If the clinical signs of intraperitoneal lesion are not present, a clinical follow-up by repeated and thorough physical examination can permit an early diagnosis. The surgical treatment is simple, and the prognosis more linked to severe associated lesions than the bowel lesion.

[Liver trauma: analysis of 42 cases in Yaounde]. / Traumatismes hépatiques: analyse d'une série de 42 cas à Yaoundé.

Forty-two cases of liver trauma were reviewed at the Central Hospital of Yaounde between 1984 and 1994. The mean patient age was 22 years, the most commonly involved age group being between 20 and 35 years. Trauma was blunt in 24 cases (57.1%) and penetrating in 18 cases (42.8%). Diagnosis was achieved most frequently by abdominal needle puncture confirming hemoperitoneum. Emergency surgery was performed in 38 cases. In the remaining 4 cases hemodynamic status was stable and surgery was not required. Lesions were classified as grade I and II in 24 cases, grade III in 5 cases, grade IV in 3 cases, and grade V in 1 case. In the remaining 9 cases the grade of the lesion was not mentioned. Management consisted of simple suture in 26 cases, debridement in one case, packing in 4 cases, and a watchful attitude in 4 cases. In 3 cases hemorrhage was uncontrollable. Overall perioperative mortality was 14.2%. The main complication was parietal sepsis which occurred in 6 cases. In the present African series liver trauma was most often benign. This finding suggests that a conservative surgical approach is indicated.

Perforation traumatique du grele et engagement occasionnel du taenia saginata : a propos de 2 observations. [Lettre]

L'engagement occasionnel de parasites a travers une breche intestinale; en dehors de l'ascaris; est un fait assez rare au Cameroun. La presence intraperitoneale du taenia saginata confirme l'hypothese d'une utilisation accidentelle par le parasite d'une perforation pre-existante. Cette presence ne modifie pas le cours de l'intervention. Le traitement antiparasitaire post-operatoire complete la destruction parasitaire mecanique peroperatoire

[Primary abscess of the psoas. A common disease in tropical countries. Apropos of 87 cases]. / Abcès primaires du psoas. Affection courante en milieu tropical. A propos de 87 cas.

Over a 4 years period, 87 cases of primary abscesses of the psoas were treated surgically at the Central Hospital in Yaoundé. The psoas muscle was involved in 10.17% of the cases with myositis. Most patients were in young male and the abscesses were in an advanced stage. Staphylococcus was the most frequently encountered germ (78.4%) and enterobacteria were only found in 3.07%. The diagnosis was based on clinical and echographic findings. There was 1 patient with acquired immunodeficiency syndrome (AIDS). Most cases were treated by extraperitoneal drainage. Morbidity and mortality were low and generally occurred in debilitated patients (AIDS, involvement of several muscle groups, diabetes).

[Voluminous ovarian cyst in children. Therapeutic strategy]. / Kyste volumineux de l'ovaire chez l'enfant. Stratégie thérapeutique.

Ovarian cysts are rare in children but can sometimes become extremely large, leading to difficult therapeutic decisions. There is general agreement that the therapeutic attitude for benign serous cysts less than 5 cm in diameter includes echographic monitoring and possible echo-guided punction. For cysts larger than 5 cm, most authors favour cystectomy via the celioscopic route using either celio-surgery or mini-laparotomy. On the contrary, the clinical manifestations of large cysts greater than 15 cm in diameter may vary greatly, presenting as increased abdominal volume, pain, respiratory impairment. The large size of the cyst should not be allowed to mask an associated torsion of the annexes in cases of paroxysmal abdominal pain. We report our experience of 6 voluminous ovarian cysts with a largest diameter varying between 15 and 40 cm. The children's age varied from 10 to 15 years. There were 3 dermoid cysts, 2 treated by ovariectomy and 1 by celio-surgery, 1 torsion of the annexes on dermoid cyst was treated via laparotomy. There were two cases of mucinous cystadenomas, 1 treated by mini-laparatomy and the other by celio-surgery. Finally one serous cyst with torsion of the annex was treated by annexectomy. The large size of the cysts may impair the surgical approach. Prudent ceilo-surgery should be preferred to wide laparotomy. Introduction should be performed under visual control followed by leak-free punction. The cyst is emptied before exeresis of the ovary via a mini-laparotomy since, in many of these cases of voluminous tumours, cystectomy cannot always be performed and ovariectomy must be preferred.