[Immunological aspects of ovarian cancer: Therapeutic perspectives]. / Aspects immunologiques du cancer de l'ovaire : perspectives thérapeutiques.

Ovarian cancer is recognized by the immunological system of its host. Initially, it is effective to destroy and eliminate the cancer. But gradually, resistant tumor cells more aggressive and those able to protect themselves by inducing immune tolerance will be selected. Immunotherapy to be effective should consider both components of immune response with an action on cytotoxic immune effectors and action on tolerance mechanisms. The manipulations of the immune system should be cautious, because the immune effects are not isolated. A theoretically efficient handling may simultaneously cause an adverse effect which was not envisaged and could neutralize the benefits of treatment. Knowledge of tolerance mechanisms set up by the tumor is for the clinician a prerequisite before they prescribe these treatments. For each cancer, the knowledge of its immunological status is a prerequisite to propose adapted immunological therapies.

Maternal mortality in Niger: a retrospective study in a high risk maternity.

OBJECTIVE: This study analyzes maternal deaths in a tertiary maternity in Niamey, Niger. METHODS: This is a retrospective study covering the period of one year, from January 1 to December 31 2007. The setting for this study was the Maternity Issaka Gazobi, a tertiary maternity referral centre in the city of Niamey, Niger. Data encompasses all hospital maternal deaths attributable to obstetric causes. The data were abstracted from emergency room, delivery rooms and hospitalization units' patient files. RESULTS: During the study period a total of 4,582 live births were registered with a total count of 121 maternal deaths, yielding a maternal mortality ratio of 2,640/100,000 live births. The mean age of deceased mothers was 26 years with a range of 15 to 43 years, and 46% of them were 15-24 years old. The most common risk factors for maternal death were primiparity (33%), haemorrhage (30%) and anaemia (22%). Most of the maternal deaths occurred post-partum (70%), 24 died peripartum, 6 died from miscarriage or abortion in association with excessive bleeding or septic complications, and one died from etopic pregnancy. Among most deaths, the burden of morbidity was important, with 57.9% of patients admitted in a state of shock from eclampsia or acute cerebral malaria. CONCLUSIONS: The high rate of mortality in this hospital testifies to the high morbidity of the patients, with anemia as an important risk factor. Maternal mortality in Niger remains high due to socio-economic factors, lack of access to quality care, and insufficient number of qualified health personnel.

[Comparative study of the LIFT and the TVT procedure in the surgical treatment of female stress urinary incontinence]. / Etude comparative du LIFT et du TVT dans le traitement chirurgical de l'incontinence urinaire chez la femme.

AIMS: The purpose of the study was to compare a polyester mesh coated with silicone (LIFT, Cousin) to a polypropylene mesh (TVT, Gynecare), in terms of results, and short and middle term complications. MATERIAL AND METHODS: We have performed a retrospective study concerning 140 patients between 2000 and 2002 (71 LIFT and 69 TVT operated for stress incontinence with or without vaginal surgery (prolapse surgery or hysterectomy). We noticed per- and postoperative complications. The patients were contacted by phone to evaluate the middle and long-term results. RESULTS: The mean age of the patients were of 58.8+/-11.3 years in LIFT group and 57.2+/-7.5 years in TVT group. More intraoperative complications arose in the TVT group (six bladder injuries and three haemorrhages versus two in LIFT group, p<0.05). There was no difference for the postoperative time. The mean follow-up was 16.6+/-5.7 months for the LIFT and 32.2+/-11.3 months for the TVT. 80% of the patients were dry in the LIFT and 75.8% in the TVT group. There was no significant difference concerning the rate of de novo urge incontinence (18.3 versus 17.7%) and voiding difficulties (10 versus 16%). On the other hand, 6.7% of the patients of the group LIFT presented bad healing with prosthesis exposure, in every case a partial resection of the mesh was performed. We did not observe any case of exposure in the TVT group. CONCLUSION: The LIFT seems as effective as the TVT with a rate of de novo urge incontinence and voiding difficulties similar to the TVT and to the literature's data. However the rate of 6.7% of exposure leads us to prefer polypropylene meshes.

Tissue resistance of the tension-free procedure: what about healing?

The aim of our work was to objectify and quantify the mechanical benefits of healing with regards to tearing meshes off of tissues and maximal resistance after cicatrization. In vivo, we tested the mechanical gain in resistance by healing after implantation of a Prolene mesh. We measured the value of forces when traction was exerted until mobilization at different stages of cicatrization. Resistance increased progressively at the beginning of tissue inclusion. A maximal plateau was reached around the 25th day. It is important to understand the role of sustaining and reinforcement we hope tissue integration of the mesh will play. We can thus adapt procedures to have the best kinetics and maximal resistance of montages. Study of the kinetics and maximal plateau allows us to make the best clinical recommendations.

[Abruptio placentae. Management in a reference Nigerien maternity. Prospective study about 118 cases during one year]. / Hématome rétroplacentaire. Prise en charge dans une maternité de référence du Niger. Etude prospective à propos de 118 cas sur un an.

OBJECTIVE: Placental abruption is a syndrome, which occurs in the third trimester of the pregnancy or during labour. It is the main cause of pregnancy last term bleeding and is also responsible for a high stillbirth rate. The objective is to describe the epidemiological, clinical, paraclinical and therapeutic characteristics in order to decrease the fetal and maternal mortality and morbidity. PATIENTS AND METHODS: It is a prospective and descriptive study in continuous series, over a twelve-month period, from 1st January 2003 to 31st December 2003, at Issaka Gazobi maternity of Niamey, Niger. RESULTS: During the study period, 3255 deliveries have been done. One hundred and eighteen placental abruptions have been observed, which corresponds to a frequency of 3.6% with the highest rate during raining season. The average age and parity were: 31 years and 5th with a predominance of grand multiparous (38.2%). The majority of the patients were in-utero transfers (83,1%) and had done at least 10 km before arriving. One hundred and eleven patients had a caesarean section (94,1%) and 7 delivered through the vaginal route (5.9%). The fetal prognosis was characterized by a high stillbirth rate of 71.3% (87/122), fetal hypotrophy (64.8%) and prematurity (23.8%). The main cause of maternal morbidity was anaemia (76.3%) and Disseminated Intravascular Coagulation (5.9%). Further, 81 patients have been transfused (68.7%). The maternal mortality was 5.1% (6/118). DISCUSSION AND CONCLUSION: Placental abruption, a medical and obstetrical emergency, is a serious obstetric condition, especially in our country. Physicians must be aware that patients with high blood pressure, preeclampsia, eclampsia, particularly in case of multiparity are at increased risk of placental abruption. Early diagnosis, prenatal follow-up and caesarean section improve the maternal and fetal prognosis.

[Tubal choriocarcinoma: a case report and review of the literature]. / Choriocarcinome tubaire: à propos d'un cas et revue de la littérature.

The authors describe a case report of a tubal choriocarcinoma occurring in women of 32 years old, 2 years after her last pregnancy. The patient was treated by laparoscopic salpingectomy and polychemotherapy. Metastatic pulmonary micronodules were diagnosed at thoraco-abdomino-pelvic tomodensitometry. Patient's recovery was complete with an uneventfull follow-up at 3 years. The association of surgical treatment and chemotherapy used under the guidelines of the FIGO score improves patient's outcome.

[Tissue resistance: what about tension-free?]. / Maintien tissulaire par friction ("frixation"): qu'attendre du tension-free?

OBJECTIVES: The purpose is to quantify objective tissue resistances before healing of prostheses used in pelvic floor surgery. PATIENTS AND METHODS: We measured tissue resistances offered to five types of meshes by four classical surgical routes. We also tested the incidence of the modification of the width of meshes on tissue resistance. This study was realized on frozen cadavers, by pull on prostheses just after implantation. Tests are realized with a dynamometer and results obtained in Newton. RESULTS: In the Retzius space, TVT offers a better resistance than IVS or LIFT meshes. We did not bring to the fore a significant difference between four routes for 1 cm wide prosthesis. The increase of width of Prolene meshes improves their resistance in tissues and thus quality of their fixation. We underscore a better resistance of the trans sacrospinous route with regard to the trans muscular one. DISCUSSION AND CONCLUSION: The increase of resistance is bound to the increase of the contact area between the prosthesis and the tissues. This increase of resistance should be taken into account in prolapse surgery: constraints are stronger than for stress incontinence. The posterior arms of meshes have to measure more than 1 cm wide and be set up through the sacrospinous ligament rather than through the elevator muscles. The type of knitting of prostheses is important and influences the resistance in tissues in the immediate postoperative time. Manufacturers should be interested in conceiving specific meshes for the tension-free fixation, with special and adapted mechanical properties.

[Uro-genital schistosomiasis with S. haematobium and infertility in Niger. Prospective study of 109 cases]. / Bilharziose uro-genitale a S. haematobium et infertilite au Niger. Etude prospective à propos de 109 consultantes.

Schistosomiasis represents the second most endemic diseases following malaria. It is now endemic in 76 countries of the world, and it is estimated that more than 200 million persons are infected. The objective of this work is to help in the improvement of knowledge about Female Genital Schistosomiasis (FSG) effects on the women reproductive. A transversal prospective survey during six months, on women consulting for infertility in the health reproductive center of Niamey. The women included (109 persons) have been asked and consulted in gynecology, cervical smears urine pathology, urine ragent strips test, vesico-renal and gynecologic trans-abdominal ultrasound, hysterosalpingography (HSG) and cervical biopsy on infected patients. The infestation prevalence at S.haematobium was 38,5%. The infected persons have presented more gyneco-obstétrical symptomatology than the non infested ones. The proportion of exocervicite was 31,0% by clinical examination. The cervical biopsy done on 26 bilharziosis patients confirmed the frequence of highs chronic exocervicites (50%) and leucoplasia (11,5%). Echography and HSG noticed that the bilharzios patients can let develop other annexiel pathologies such as: ovary cyst, peri-tuboovary adhesions and wide ovaries. The symptomatology felt by infested women showed the parasitose consequence on women in endemic area. The treatment in o large schaddle by the national program allows to reduce morbidity caused by that infection in Niger.

[Acceptability of intrauterine levonorgestrel delivery system (Mirena 52mg) after estrogen-progesterone oral contraception: results of a prospective multicentric study of 211 patients aged 25-35 years]. / Acceptabilité du système intra-utérin au lévonorgestrel Mirena 52 mg après contraception orale oestroprogestative: résultats à 1 an d'une étude prospective multicentrique sur 211 patientes de 25 à 35 ans.

INTRODUCTION: Use of an intrauterine levonorgestrel (SIU-LNG) delivery system (Mirena 52mg has become popular in recent years, particularly among younger women. Mirena is currently the contraceptive method of choice used as an alternative to classical copper-containing intrauterine devices after oral contraception. The purpose of this study was to evaluate patient satisfaction among young women during the first year of use of the intrauterine hormonal system. MATERIAL AND METHODS: This multicentric phase IV trial with a non-comparative methodology was conducted among 211 young women aged 25-35 years. The SIU-LNG was prescribed for women who wanted to change their contraception after oral estrogen progesterone taken for at least three months prior to inclusion in the study. A total of 211 patients were included and review was planned at one year: 197 patients (93.36%) were reviewed. RESULTS: Mean patient age was 31.48+/-3.25 years. The SIU-LNG was inserted successfully at the first attempt in 99.05% of women. The continuation rate ws 85.65% at one year. Evaluation of cycle characteristics showed less voluminous blood loss and fewer dysmenorrheal phenomena as well as, in 40%, the development of amenorrhea. At the last visit, 85% of women were satisfied or very satisfied with this method of contraception. CONCLUSION: As has been demonstrated in earlier studies, Mirena offers a contraception with a reliability equivalent to that of oral estrogen progesterone (IP: 0 - 0.2), with very few hormonal side effects due to the low plasma passage of levonorgestrel. Mirena is particularly well adapted for young women who desire a reliable long-term easty-to-use contraception after taking oral contraception.

[Uterine horn rupture at 23 weeks gestation: a case report]. / Rupture utérine sur corne rudimentaire à 23 semaines d'aménorrhée: à propos d'un cas.

Bicornuate uterus with rudimentary horn is a rare disability. Pregnancy can accidentally settle inside the rudimentary horn; in this case, it becomes apparent by uterine rupture generally in the second trimester. Bicornuate uterus should be diagnosed early, before pregnancy if possible. Abdominal pain of unknown origin occurring during the second trimester of pregnancy is the most frequent sign.

[Haemostatic hysterectomies in developing countries: A vital act. Prospective study in a reference Nigerian maternity]. / Les hystérectomies d'hémostase en pays sous-équipé: un geste vital. Etude prospective dans une maternité de référence au Niger.

OBJECTIVE: The purpose of our prospective study was to determine the frequency, the main indications and difficulties of coverage of the peripartum haemostatic hysterectomy in a developing country. The secondary purpose was to assess the maternal forecast and suggest suited management and to estimate the necessary material and human means to reduce the incidence of this surgery. PATIENTS AND METHODS: We realized a forward-looking monocentric study in the Issaka Gazobi maternity of Niamey, between January 1st, 2003 and December 31st, 2003. RESULTS: 3255 deliveries took place, and 41 peripartum haemostatic hysterectomies for post-partum haemorrhage were realized (ie 1.26%). The mean age of our patients was 32.76. The multiparous (more than 5 children) were most often concerned. The majority of patients had benefited from an in utero transfer. 31 patients presented an active bleeding, 11 were in a state of shock during the admittance. The main indications of hysterectomies were represented by an abruptio haematoma, uterine inertia, a rupture of the uterus, a wound of the genital field, 1 placenta accreta with uterine inversion. In a third part of the cases a disseminated intravascular coagulation was associated to the clinical picture. The hysterectomy was subtotal in most of the cases. Finally, the rate of maternal death is high in our series. DISCUSSION AND CONCLUSION: Prevention of post-partum haemostatic haemorrhage and new therapeutic strategies are essential to reduce the rate of haemostatic hysterectomy in our regions, and improve the coverage of this pathology. However, it is a vital surgery which must be technically mastered.

[Intra-uterine arteriovenous malformations]. / Les malformations artério-veineuses intra-utérines.

Intra-uterine arteriovenous malformations are a possible etiology of persistent metrorrhagia especially in the event of a history of miscarriages, cornuale pregnancy, molar pregnancy or gravidic trophoblastic diseases. We report 4 cases of patients having an intra-uterine arteriovenous malformation. The diagnosis of such lesions calls upon first intention Doppler echography. This diagnosis is confirmed thereafter by angiography. The first intention treatment is embolization which can save time if carried out at the same time as the angiography. This treatment is rapid and final, enabling the patients to have other pregnancies later on. An echographic follow-up, according to a schedule which remains to be defined, is necessary in order to check the good involution of this type of vascular malformation.

[Acute per-partum feto-fetal transfusion. A case study on two sets of twins]. / La transfusion foeto-foetale per-partum: à propos de deux observations.

Description of acute per-partum feto-fetal transfusion. The risk of twin-twin transfusion syndrome in monochorionic twin pregnancies is well known. This pathology starts in the second trimester and has a chronic course. Acute per-partum feto-fetal transfusion seems to be less frequent and has not been studied. In the study, we described two cases of acute per-partum feto-fetal transfusion. The outcomes of the pregnancies were as follows: following a successful delivery, the first set of twins presented hypovolemic shock at birth due to an acute anemia. The second set of twins was polyglobulic, but otherwise healthy at birth. The risk of hypovolemic shock seems to be unpredictable, even if the pregnancy is monitored. Obstetricians and pediatricians must keep this pathology in mind when dealing with this kind of pregnancy. Moreover, it would be interesting to obtain systematically a full blood count of each set of twins of monochorionic pregnancies, in order to detect every case of feto-oetal transfusion.

[Management of ectopic pregnancy in developing countries: example of a Nigerian reference maternity]. / Prise en charge de la grossesse extra-utérine dans les pays en voie de développement: exemple d'une maternité de référence au Niger.

OBJECTIVE: We report 143 cases of ectopic pregnancy (EP) treated in the Issaka-Gazobi maternity of Niamey between January 1st, 1999 and April 30th, 2001 (28 months). The objective of this study was to estimate the epidemiological, diagnostic and therapeutic aspects to propose actions, which could lead to the improvement of the prognosis of EP. PATIENTS AND METHODS: The frequency of ectopic pregnancy was 2.32% in our study. The patients were young and pregnant for the second or third time. Frequently we observed previous sexually contagious infections and/or abortions. More than 70% of the patients were admitted for a complicated stage of EP. RESULTS: The culdocentesis allowed to evoke the diagnosis in more than 80% of the cases. It is a simple gesture, which makes it possible to make the diagnosis of EP and which should be taught and practised in maternities of the developing countries. The pelvic ultrasonography and the laparoscopy allowed the diagnosis in the other cases. The tubal localization was the most frequent, cervical and abdominal pregnancies were found. The surgical treatment conducted by laparotomy was conservative in 11.9% and radical in 87.4% of the cases. The mortality rate was still 0.70%. DISCUSSION AND CONCLUSION: Prevention of the sexually contagious infections and medical management of abortions are important to reduce the risks of ectopic pregnancies. Education of the patients, living far from the maternity, is also necessary to obtain more precocious consultation in case of pregnancy in order to improve the prognosis of EP.

[Epidemiological and histological aspects of gynecologic and breast cancer in the pathology department of Niamey's Health Faculty, Niger]. / Cancers gynecologiques et mammaires: aspects epidemiologiques et histologiques dans le service d'anatomie et cytologie pathologique de la Faculte des Sciences et de la Sante de Niamey Niger.

INTRODUCTION: The aim of this study is to identify the epidemiological and histological aspects of gynaecologic and breast cancer for a best care of patients. METHODOLOGY: A restropective and descriptive study have been realised in the Histopathologic laboratory of Niamey's Health faculty department, Niger. During 9 years (01 January 1992 to 31 December 2000), we brought up all cases of gynaecological and breast cancer. We analysed epidemiologic characteristics of patients, the histological type of cancer. RESULTS: Gynaecologic and breast cancer reprensented 54.3% of woman cancer and 33.1% of diagnosed cancer of both sex. Patients mean age was 36.5 years (extreme 9 to 79 years). The most frequent site was breast (40.4%) follow by cervix (26%). The distribution according to histoloigical group have detected a neat predominance of epitheliale tumours (87%). Sarcoma represents 7.9% of case and 5.1% for the other histological types. CONCLUSION: Despite the results, suggestions have been formulated for epidemiological and histological follow up of gynecologic and breast cancer in Niger.

[Spontaneous intrauterine depression skull: myth or reality?]. / Traumatismes crâniens obstétricaux spontanés: mythe ou réalité?

In spite of the fact that there are many articles considering that intrauterine depressed skull fractures are caused essentially by instrumental extraction, literature is scarce about spontaneous foetal head injuries. Here, we report the case of two depressed skull fractures and one of linear fracture not associated with any known trauma during the pregnancy or delivery. The etiological process leading to the idiopathic character of such lesions, the aetiology, the treatment and the prognostic will be discussed. The forensic problem raised by such cases is very important.

[Promontofixation procedure: use of non-absorbable sutures or Tackers?]. / Technique de la promontofixation: suspension au promontoire par fils ou Tackers?

AIM: Description and evaluation of ligamentopexy techniques using strings and spiral staples. MATERIAL AND METHODS: We first describe the ligamentopexy procedure using non-absorbable sutures before comparing this technique to the use of Tacker type staples. We describe the advantages and disadvantages of this procedure in terms of surgical technique, secondary complications and biomechanical strength. RESULTS: For our team, recommendable attitude is to use non-absorbable sutures for the fixation to the prevertebral ligament. The main advantages of the use of staples are the ease and facility for learning the technique. The risk of spondylodiscitis is rare but enhanced by the deeper penetration of the staples into the intervertebral discs. In terms of resistanc, promontofixation using sutures is much stronger compared to staples. CONCLUSION: The use of sutures for promontofixation, in laparoscopy, is preferred to the utilization of staples type Tacker. These staples should be used when there is a risk of needle stitches for the patient.

[Comparative analysis of rate scales of urinary incontinence in women]. / Analyse comparative des échelles d'évaluation de l'incontinence urinaire chez la femme.

OBJECTIVE: Rate scales are used to analyse urinary incontinence. There are many scales making it difficult to compare the different studies of urinary incontinence. The purpose of this study was to evaluate and compare the rate scales pertaining specifically to urinary incontinence. PATIENTS AND METHOD: A review of the literature was performed for publications specifically addressing rate scales of urinary incontinence. Each scale was evaluated using the following four criteria: principal characteristics (reference source, number of items addressed, scoring method, language), objectives (type of incontinence, severity and quality of life measures), psychometric properties (scientific validity, reliability and responsiveness) and linguistic validation. RESULTS: Thirteen scales were identified. These were divided into two groups: (1) those based on "classifications" and (2) those based on specific questionnaires. Scales based on classifications were not precise and are never scientifically validated. Scales based on questionnaires were more elaborate and more detailed; nevertheless, the study of their psychometric properties was often incomplete. DISCUSSION AND CONCLUSION: Classification-based rate scales are inadequate to analyse urinary incontinence. Questionnaire-based rate scales are superior, but at minimum, they should address the previously stated objective and psychometric criteria. The choice of questionnaire should depend on whether it is to be used in clinical practice or for research protocol.

[Dystocia by excess volume of the fetal abdomen: a case of giant polycystic kidney]. / Dystocie par excès de volume de l'abdomen foetal: un cas de polykystose rénale géante.

We describe a case of dystocia by excess of fetal abdominal part related to giant polycystic renal disease. We list the fetal malformations leading to dystocia and discuss the choice between embryotomy and cesarean section, particularly in countries were no prenatal diagnosis can be made.