[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.

[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.

[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.

[Serology of Chlamydia and ectopic pregnancies. Incidence of Fitz-Hugh-Curtis syndrome]. / Sérologie des Chlamydiae et grossesse extra-utérine. Fréquence du syndrome de Fitz-Hugh-Curtis.

The authors report a prospective study of anti-chlamydia trachomatis serology in extra-uterine pregnancies, which happened to coincide with an increase in the ectopic rate during the year 1989 (p less than 1.10(-6]. The subjects of the study were those patients operated on for ectopic pregnancy between the 1st January and the 31st May 1989. There were two control groups: the first were those that were delivered and the second were those pregnant women who were at risk of ectopic pregnancy because of their age, or the number of pregnancies they had had and their parity, without taking any account of the duration of the pregnancy. The level for sero-positive reading was 1 in 64 using an indirect immunofluorescent method (Spot IF, Bio Merieux). The results showed 81% sero-positive in those who had had ectopic pregnancies as against 63% in the control groups. The two control groups had identical readings. There was a significant difference statistically (p less than 0.01). There was no statistical difference in the incidence of HIV (human immunodeficiency virus) in the two groups (3% and 1%). The clinical study of the other tube showed no particular lesions. On the other hand, adhesions between the liver and the diaphragm (Fitz-Hugh-Curtis Syndrome) were demonstrated in 34% of those with ectopic pregnancy with a statistical significant level of igG above or equal to 1:128 (p 0.02). Perisplenitis was rare (3 cases). Histological finding of salpingitis isthmica nodosa in 49% of cases raises the problem of the pathology of chlamydial lesions being due to a host invader reaction. The increase in the incidence of ectopic pregnancy (1 in 44 deliveries) was accompanied by an increase in the prevalence of chlamydia trachomatis in the group with ectopics and the control groups. If the frequency of ectopics creates a major problem of public hygiene, the prevalence of chlamydia in the female population, apart from its effect on fertility, explains the action of sexually transmitted diseases as a factor in the heterosexual transmission of HIV in Africa.

PIP: A prospective study of antichlamydia trachomatis serology in extrauterine pregnancies which coincided with an increase in the rate of ectopic pregnancy during the year 1989 (p1.10-6) is reported. The subjects were patients operated on for ectopic pregnancy between January 1-May 31, 1989. There were 2 control groups, those who were delivered and those who were at risk for ectopic pregnancy because of their age or their parity. The level for seropositive reading was 1 in 64 using a direct immunofluorescent method (Spot IF, Bio Merieux). Results showed 81% seropositive in those who had ectopic pregnancies as compared with 63% in the control groups. The 2 control groups had identical readings. There was a significant difference statistically (p.01) but there was no statistical difference in the incidence of HIV among the 2 groups (3% and 1%). The clinical study of the other tube showed no specific lesions. However, adhesions between the liver and diaphragm (Fitz-Hugh-Curtis syndrome) were demonstrated in 34% of those with ectopic pregnancy with a statistically significant level of IgG or= 1:128 (p.02). Perisplenitis was rare (3 cases). Histological findings of salpingitis isthmica nodosa in 49% of the cases raises the problem of pathology of chlamydial lesions due to a host invader reaction. The increase in incidence of ectopic pregnancy (1 in 44 deliveries) was accompanied by an increase in prevalence of chlamydia trachomatis among the group of ectopics and the controls. If the frequency of ectopics creates a major problem with public hygiene, the prevalence of chlamydia among the female population, apart from its effect on fertility, explains the action of sexually transmitted diseases as a factor in the heterosexual transmission of HIV in Africa. (author's modified)

[Malaria and pregnancy. Comparative study of Central Africa and Western Africa]. / Paludisme et grossesse. Etude comparative entre l'Afrique Centrale et l'Afrique de l'Ouest.

The transmission of malaria occurs mainly in and following the rainy season (intermittent transmission) in the Sahelian zone of Africa. On the other hand in rainy Equatorial Africa the transmission of malaria is continuous so that it is stable and can give rise to continuous antigenic stimulation in pregnant women which in turn gives rise to passive early high level immunity in the infant. 150 couples of mother and cord blood and 206 placentae were studied. We found 12.1% of carriers of blood parasites in the blood as compared with 1.6% in the cord bloods (exclusively P. falciparum). Where there were medium quantities of fluorescent antibodies in the mothers 74% could be found in the cord serum. Two methods were used to measure antimalarial antibodies as evidence of infection and also partly protective: the first method was indirect immunofluorescence, and the second was co-electrosyneresis. There was a narrow correlation between the level of precipitant antibodies in the mothers who were infected and in the fetal cord bloods. Anatomo-pathological examination of the placenta showed that 2 out of the 206 had parasites in them, 9 out of the 206 had fibrin deposits around the villi and 6.8% of the placentae showed lesions of malaria. On the other hand, in West Africa there was very little maternal morbidity as evidence by fever and anaemia, or of fetal morbidity. There was no single case of congenital malaria. The levels of the plasma indices in the towns could be explained because of prophylaxis which was both controlled and uncontrolled.