Prise en charge chirurgicale des cancers du sein au Centre Hospitalier Universitaire d'Angondjé, à Libreville au Gabon

Objectif : Déterminer la fréquence, le pronostic et la morbidité des patientes opérées pour cancer du sein.Matériel et Méthodes : Il s'agit d'une étude rétrospective, descriptive et analytique, sur une période de trois ans, allant de janvier 2013 à janvier 2017. Elle a porté sur les patientes opérées pour cancer du sein dans le service de gynécologie obstétrique et à l'Institut de Cancérologie du Centre Hospitalier Universitaire d'Angondjé (CHUA) de Libreville. Les informations recueillies ont été analysées à l'aide du logiciel R. Résultats : Un total de 51 patientes a été colligé. La moyenne d'âge des patientes était de 50 ans avec des extrêmes de 27 et 88 ans. Le délai moyen de consultation était de 56 semaines avec des extrêmes de 3 et 288 semaines. Le délai moyen entre la consultation et la preuve histologique était de 60 semaines avec des extrêmes de 2 et 288 semaines. Au moment du diagnostic, 65,2 % des patientes étaient au stade III de la classification de l'Union Internationale Contre le Cancer et 66% avaient un carcinome canalaire infiltrant. La mastectomie totale selon Madden et le curage ganglionnaire ont été réalisés respectivement dans 78,4% et 86,3 des cas. L'envahissement ganglionnaire a été constaté dans 60% des femmes. En tout, 33,3% des patientes ont présenté des complications post-opératoires, dont 13,7% de lymphocèle.Conclusion : la prise en charge chirurgicale des cancers du sein est dominée par la mastectomie modifiée type Madden, avec une faible morbidité post opératoire

Cervical cancer in sub-Saharan Africa: an emerging and preventable disease associated with oncogenic human papillomavirus.

Highly oncogenic human papillomavirus (HPV) infections are responsible for 7.7 % of cancers in developing countries, mainly cervical cancer. The incidence of this emerging cancer is steadily increasing in sub-Saharan Africa, with more than 75,000 new cases and close to 50,000 deaths a year, a toll further increased by HIV infection. According to the World Health Organization, cervical cancer will kill more than 443,000 women per year worldwide by 2030, nearly 90 % of them in sub-Saharan Africa. This increase in cervical cancer incidence in Africa is now counteracting the progress made by African women in reducing maternal mortality and increasing longevity. Nevertheless, cervical cancer is a potentially preventable noncommunicable disease that can be averted or halted by primary (vaccination), secondary (early diagnosis of situations at risk), and tertiary (early diagnosis of proven cases of cervical neoplasia) prevention. The close links between HIV and HPV justify linking cervical cancer prevention, screening, and management programs with AIDS programs as part of the "90-90-90" initiative of the UNAIDS, both nationally and regionally. Innovative strategies based on effective, rapid, inexpensive, and mobile screening tools, including at best molecular biology as well as vaccination and awareness programs, should be rapidly implemented and evaluated in sub-Saharan Africa.

[Abdominal pregnancy in Libreville from 1999 to 2009]. / Grossesse abdominale à Libreville de 1999 à 2009.

INTRODUCTION: Abdominal pregnancy (AP) is defined as the implantation and development of the fertilised egg in the cavity of peritoneum. It causes severe perinatal morbity and mortality. OBJECTIVE: Underline the epidemiologic, diagnostic, therapeutic and prognostic aspects of the AP. METHODOLOGY: Retrospective study conducted at Maternité Joséphine Bongo (maternity hospital) and at the Centre Hospitalier de Libreville (hospital centre) from January 1999 to December 2009 on 19 cases of abdominal pregnancies. RESULTS: The frequency of AP in Libreville is one per 4447 deliveries (0.2 ‰) and one per 141 tubal ectopic pregnancies (0.7%). The mean age was 30.5 ± 7.2 years old and the mean parity 2.7 ± 1.7. The mean term of occurrence was 24.3 weeks of amenorrhoea (WA) with extremes at 14 and 39 WA. The diagnosis was made in the face of abdominal and pelvic pains in all the patients and an amenorrhoea in 11 cases (57%). It was confirmed by ultrasound scan in 14 cases (73.7%) and further to a laparotomy in five (26.3%) patients. We had two live births at 39 and 38 WA with respective birth weights of 2,380 and 2,550 g. Expulsion of the placenta was complete in seven (36.8%) cases. Five (26.3%) patients experienced hemorrhagic complications. CONCLUSION: AP is a rare pathology. Its diagnosis beyond of the second quarter is difficult with an often-pejorative foetal forecast.

[Fetal distress: Information provided by lactate levels and antioxidant status, compared with the Apgar score]. / Souffrance foetale: pouvoir informant des lactates et du statut antioxydant versus le score d'Apgar.

The multitude of criteria used to assess fetal distress and the subjective character of the Apgar score led us to compare the information it provides with that from measurements of lactate and two principal antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx). We measured plasma lactates, SOD, and GPX from the umbilical cord blood of live-born children whose mothers had had at least three prenatal consultations. The correlation of these measurements with the 5-minute Apgar score was tested with the Spearman correlation coefficient. Lactate levels were correlated with the baby's blood glucose (r=0.212; p=0.0084), and GPx activity (r=0.179; p=0.0061), the Apgar score (r=0.258; p=0.001) and the mother's blood glucose (r=0.167; p=0.035). GPx was correlated not only with the lactate level but also with birth weight (r=0.205; p=0.000) and height (r=0.316; p=0.0056), while SOD was correlated only with the mother's blood glucose (r=0.161; p=0.046). In multivariate analysis, followed by stepwise analysis, lactate was the main variable associated with the Apgar score. It thus seems better able to replace the Apgar score than the antioxidant enzyme levels. GPx was higher in children of high birth weight and may make them better able to combat the free radicals due to anoxia or hypoxia.

[Risk factors of bilateralization of breast cancer: description of five cases in Libreville (Gabon) and review of the literature]. / Facteurs de risque de bilatéralisation du cancer mammaire: cinq observations à Libreville (Gabon).

Approximately 10% of patients diagnosed with breast cancer will develop cancer in the contralateral breast within 10 years. The risk factors for bilateralization are now better understood thanks to advances in molecular biology. Based on reports in the literature the main risk factors are presence of brca 1 or 2 gene mutations and family history. Despite the increasing incidence of breast cancer, this special aspect of the disease remains poorly studied in Gabon as well as in Black Africa in general. Incidence is increasing. This report describes 5 patients and discusses their profiles in relation to the literature. This study provides on update on current knowledge.

[Prognosis of twin deliveries in an African milieu]. / Prognostic de l'accouchement gémellaire en milieu africain.

We carried out a retrospective study of 101 multiple pregnancies between January 1st 1997 and June 30 1999, to investigate the prognosis of twin deliveries at the Josephine Bongo Maternity Unit. The frequency of twin deliveries was 2.22%, corresponding to over 1 in 45 deliveries. Mean birth weight was 2,309.6 +/- 369.31 g for the first twin and 2,234.31 +/- 397.58 g for the second twin. The frequency of cesarean section was 11% for the first twin and 18% for the second twin. The neonatal mortality rate was 30 per thousand for the first twin and 50 per thousand for the second twin. The reorganization of mother and child health services would help to improve fetal prognosis in twin deliveries.

[Position of cervix cancer detection in Gabon over a period of 19 years]. / Place du dépistage du cancer du col utérin au Gabon, étude sur 19 ans: 1977-1995.

MATERIALS AND METHODS: We report the contribution of the cytology test for screening for cervix cancer in Gabon observed in a retrospective study over 19 years (1977-1995). Data from the Libreville Faculty of Medicine cytohistopathology laboratory were used. RESULTS: Over the 19-year period, 10,838 PAP smears were performed, an average of 570,42 smears per year. Sixty-eight cases of cervix cancer were diagnosed with this test: 40 invasive carcinomas (58.83%), 5 microinvasive carcinomas (7.35%), and 23 in situ carcinomas (33.82%). During the same period, 437 cervix cancers were reported in the same laboratory without prior cytology test. CONCLUSION: In Gabon, cervix cancer is usually diagnosed at an invasive stage, hence the need for systematic detection.

[Endometrial carcinomas in Gabon. A study of 34 cases in 11 years: 1988-1998]. / Carcinomes de léndomètre au Gabon. Etude de 34 cas sur 11 ans: 1988-1998.

The aim of this retrospective study was to determine the importance of endometrium cancer in Gabon over an eleven-year period (1988-1998). We studied 34 cases from the register of cancers at the Faculty of Medicine in Libreville. The incidence of endometrium cancers was 5.3%. The patients came from areas with medical care facilities. They were all mature women with a mean age of 58.8 years (range: 34 to 80 years). Most of these women were menopausal (88. 24%). Uterine bleeding was the main symptom (100% of cases). Histologically, endometrium adenocarcinomas (79.41%) were the most frequently observed. The setting up of medical facilities in rural areas and efforts to provide the population with information concerning these cancers may affect the incidence and prognosis of endometrium cancer in Gabon.