[Perioperative morbidity and mortality in a developing country: experience of Lomé teaching hospital]. / Morbidité-mortalité périopératoire dans un pays en développement: expérience du CHU de Lomé (Togo).

OBJECTIVE: New evaluation of early perioperative morbidity and mortality four years after the first study in 2002, at Lomé teaching hospital (Togo). PATIENTS AND METHODS: It was a prospective and descriptive survey during the first semester of 2006. After approval of hospital ethic committee, medical and demographic data, complications and early perioperative deaths have been analyzed. RESULTS: One thousand nine hundred and two anaesthesia was delivered: 58% were women, the average age was 26 years, 94% of patient ASA<3, general anaesthesia (GA) 53% versus regional anaesthesia (LRA): 47%. Spinal anaesthesia (SA) represented 42% of anaesthetic procedures, and emergencies, 56%. 5.49% of complications including 16.16% of deaths were recorded. Death occurred in 69% after GA, and in 60% in the operating room. Seventy percent of patients had cardiovascular complications (five deaths), 30% respiratory failure (six deaths), 11% kidney failures (two deaths). Three deaths were linked to surgery (inadequate management of perioperative haemorrhage). Early perioperative mortality rate was 0.89%. Four cases occurred in the operating room and 12 in intensive care. Deaths were observed often in gynecology and obstetrics (9/16), especially in emergency situations (12/16) and in 75% of cases, patients were ASA>2. Deaths occurred in 13 cases after GA and in three cases after SA. CONCLUSION: This mortality rate was smaller than in 2002. This may be explained by a better prenanaesthetic risk evaluation performed by anaesthetists, the creation of postoperative recovery room, the promotion of regional anaesthesia and the availability of succinylcholine in obstetrics. Significant improvement is still necessary and only be obtained by a national health policy.

L'endométriose: une pathologie ignorée dans les centres de formation de base en santé de Lomé

Le travail realise est une evaluation sur les connaissances de l'endometriose dans les centres de formation de base en sante au Togo par une enquete afin de preciser l'ignorance ou la meconnaissance de cette affection au Togo. Une revue de la litterature sur l'endometriose a eu pour objectif de fournir aux praticiens togolais les outils recents de son diagnostic et de sa prise en charge. Resultats L'endometriose est une pathologie frequente dans la population generale. Elle est benigne mais peut induire des consequences lourdes pour les patientes en terme de qualite de vie; de projet parenteral et de traitements medicaux et chirurgicaux iteratifs. Si sa clinique et sa prise en charge sont bien connues dans les pays medicalises; cela n'est pas le cas pour les etudiants en fin de formation dans les centres de sante de base de Lome. En effet la totalite des etudiants enquetes ignore sa clinique et sa prise en charge. Sa clinique repose sur des symptomes varies domines par la dysmenorrhee; les menometrorragies; la dyspareunie; les douleurs abdomino-pelviennnes. Son diagnostic de certitude repose sur la coelioscopie et l'examen anatomopathologique. Son traitement repose sur les oestroprogestatifs qui peuvent etre utilises comme tests therapeutiques dans les pays sous medicalises comme le Togo. L'ignorance ou la meconnaissance de cette affection par le personnel medical et paramedical peut conduire les femmes atteintes vers la medecine traditionnelle et la religion. Conclusion L'endometriose est une affection ignoree dans les centres de formation de base en sante du Togo. Son existence au Togo reste a prouver grace aux tests therapeutiques oestroprogestatifs chez les femmes suspectes et si possible par la coelioscopie et l'anatomopathologie

Problématique du dépistage du cancer du col de l'utérus dans les pays en voie de developpement

Introduction et Objectifs Le travail realise est une revue de la litterature sur le depistage du cancer du col de l'uterus. Ses objectifs ont ete d'analyser quelques modeles de depistages du cancer du col dans le monde et de determiner les probables causes de l'echec des programmes de depistage dans les pays en voie de developpement (PVD) Resultats : Le cancer du col de l'uterus est le cancer le plus frequent chez la femme dans les PVD avec une incidence plus de six fois superieure a celle des pays developpes et constitue la principale cause de deces par cancer chez les femmes des PVD. Dans les pays developpes; l'incidence et le taux de mortalite dus au cancer du col de l'uterus sont en perpetuelle regression grace a la mise en place des programmes de depistage; de traitement et d'orientation structures et exhaustifs. Cependant; la mise en oeuvre de ces programmes necessite des ressources considerables et un degre eleve de coordination. Ces programmes sont donc peu pratiques et trop couteux dans le contexte des milieux a faibles ressources. Or; les femmes des PVD meritent d'avoir acces a des services de prevention du cancer du col uterin surs; efficaces et abordables. Compte tenu des obstacles reconnus quant a la mise en oeuvre de mesures de depistage fondees sur la cytologie et du caractere limite de la gamme de traitements disponibles; d'autres options de programme sont requises comme le depistage par le test IVA (Inspection Visuelle a l'Acide acetique) et IVL (Inspection Visuelle au Lugol) et des options de traitement sans hospitalisation. Bien que des efforts pour reduire l'impact sur la sante du cancer du col aient ete entrepris dans le monde entier; la plupart des tentatives ont echoue dans les PVD [14; 35; 36]. C'est le cas du Bresil; du Mexique; de la Colombie; de l'Afrique du sud; ou de l'Inde [14]. Les ressources limitees et le fait que le cancer ne constitue pas la preoccupation majeure des politiques en matiere de la sante sont les causes majeures de cet echec. Conclusion Ce travail a identifie certaines causes de l'echec des programme de depistage du cancer du col de l'uterus dans les PVD et ouvre la possibilite pour ces pays de reajuster leur programme de lutte contre le cancer du col de l'uterus pour le rendre efficace et de pouvoir releguer ce cancer au dernier rang des cancers chez la femme

[Knowledge and acceptance of obstetric peridural analgesia: survey of pregnant women in Togo]. / Niveau de connaissance et acceptabilité e l'analgésie péridurale: enquête auprès des femmes enceintes au Togo.

The purpose of this study was to evaluate knowledge and acceptance of obstetric peridural analgesia among pregnant women in Togo. A prospective, descriptive survey was carried out over a period of one month. A standardized survey form was used to collect data. A total of 303 pregnant women with a mean age of 27 +/- 6 years were interviewed. A proportion of primiparous and multiparous was the same, i.e., 50%. Among multiparous women, 83.5% described labor pain during previous deliveries as severe. Twelve percent of the pregnant women interviewed claimed knowledge of techniques to control labor pain. Three pregnant women reported a detailed understanding of peridural analgesia obtained from the Internet. A total of 253 women (83.5%) replied affirmatively when asked if they would opt for peridural analgesia if it was offered free of charge for delivery at the end of the current pregnancy. Acceptance was motivated by better delivery conditions for the newborn (112 women) and comfort achieved by pain relief (130 women). Refusal was motivated by a religious belief that painful delivery was in the natural order (31 women). Among the six Moslem women that refused painless delivery, two from the Djerma ethnic group stated that pain was the best expression of their femininity. The acceptance rate fell from 83.5% to 70% if peridural analgesia was offered at extra charge. Most pregnant women in Togo expressed interest in trying peridural analgesia. It is compulsory in medical indications.

[Contribution of ultrasonography to the diagnosis of non-hormonal acquired clitoromegalia: a case report]. / Place de l'échographie dans le diagnostic des clitoromégalies acquises non hormonales: à partir d'un cas.

We report the case of a 30-year-old woman, consulting for a painful clitoromegaly which developed progressively and rapidly. The gyneco-endocrinological assessment ruled out hyperandrogenism. Ultrasound examination of the clitoris revealed the presence of a clitoral cyst. Acquired clitoromegaly is a symptom which occurs in severe hyperandrogenism. Other organic etiologies include clitoral cysts of various nature and solid tumors. An ultrasonographic examination should be included in the diagnostic work-up for acquired clitoromegaly.

[Delayed autologous transfusion: about 70 surgical patients at the Saint-Jean-de-Dieu Hospital in Afagnan, Togo]. / Transfusion autologue différée: apropos de 70 cas a l'hôpital Saint-Jean-de-Dieu d'Afagnan, Togo.

This prospective study was conducted from 2000, September the 1st to October the 31st, at the Saint-Jean-de-Dieu Hospital in Afagnan (Togo). All the 75 patients who received indication of autologous blood transfusion (ABT) accepted the protocol; 70 out of them, among whom 63% were female, benefited an ABT The age of the patients varies between 13 and 80 years old (average 33.2). Initial rate of haemoglobin was on average of 11.7 g/dl; 14% of these patients had a haemoglobin diseases. The most frequent interventions were hysterectomies (21%), bone surgery (16%), prostatectomies (11). Only one blood unit was taken from 63 patients and two units from the 7 others inducing giddiness (5) and headaches (1). During intra and postoperative periods, 41 patients were given 45 units of blood (use rate: 58%). The percentage of patients who received transfusion was 56% in gynaecological surgery 79% in orthopaedics and 88% in urology. Only one patient received an additional homologous unit of blood. The rate of haemoglobin was on average 10.2 g/dl the day after surgery. No incident in connection with the ABT was recorded. The ABT is a feasible, effective and secure method in the context of a small African hospital. It may be a solution to the problems of shortage of blood products and transfusion safety. Training and motivation are necessary for its successful implementation.

[Practice of the thromboembolic disease prophylaxis: a survey among surgeons and anaesthetists in Togo]. / Pratique de la prophylaxie de la maladie thromboembolique veineuse: enquête auprès des chirurgiens et anesthésistes au Togo.

OBJECTIVE: The aim of this study was to analyse the current practice of postoperative venous thromboembolism (VTE) prophylaxis among anaesthetists, nurse anaesthetist and general surgeons in Togo. METHOD: A total of 160 questionnaires were distributed to anaesthetists and surgeons with varying subspeciality interests. RESULTS: One hundred and three (64%) (3 anaesthetists, 51 nurse anaesthetists and 49 surgeons) returned the questionnaire. Of these, 16% thought that VTE was as common in Togo as in the western countries. Selective VTE prophylaxis was used by 78% of the prescriptors. In order of frequency, indications for selective VTE prophylaxis were obesity, increased risk of VTE related to surgery and past medical history of VTE. Orthopaedic surgery, caesarean section and vascular surgery were most frequently considered as high-risk surgery for VTE event. When prophylaxis was indicated, low molecular weight heparin was prescribed by 87% of prescriptors. In most cases, VTE prophylaxis duration was less than a week. In 92% of institutions, there was no written protocol for VTE prophylaxis. VTE-related morbidity was reported by 34% of the prescriptors over the past year, and 30% of these cases were fatal; 60% of the prescriptors observed these complications one week after the surgery. CONCLUSION: The practice of VTE prophylaxis in Togo is not sufficient. It is necessary to promote the training of practitioners, particularly of physicians.

[Maternal deaths and anesthetics in the Lomé (Togo) University Hospital]. / Mortalité maternelle: implication anesthésique au CHU de Lomée (Togo).

AIM: To assess the results of anesthesia practices in a department particularly inadequately staffed with physicians specializing in anesthesiology. SETTING AND METHODS: This six-month prospective study (from January through June 2002) took place in the anesthesiology/intensive care unit of the obstetrics and gynecology department of Lomé University Hospital Center. A case report file was completed for each patient, and all anesthetics administered in the obstetrical department (labor and delivery room) were recorded and considered. We examined the perinatal deaths among women who underwent surgery. RESULTS: Anesthetics were administered to 318 women during cesarean delivery (306) and uterine scar repair (12). Nearly all patients (98%) were classified in categories 1 or 2 of the ASA physical status classification system (healthy or mild systemic disease). General anesthesia was induced in 95.9% of the women and spinal bloc used for 4.1%. Thiopental was used most often, and certain drugs, including succinylcholine and ephedrine, were not available as needed. Intraoperative monitoring was essentially nonexistent. Emergency situations accounted for 89.6% of these surgical procedures. Of the 16 cases requiring transfusions, an inadequate supply of blood products or the patient's inability to obtain blood was reported in 14 of the cases. Twelve deaths occurred, for a mortality rate among surgical patients of 3.8%. The principal causes of death were respiratory complications of anesthesia and of pregnancy-related toxemia and the unavailability of hypertonic solutions and blood products. CONCLUSION: The results of this survey show that anesthetics play a role in maternal mortality in Togo. Good practice guidelines adapted to this setting must therefore be developed.