The case series of functional adrenal tumors: Experience of two tertiary hospitals in Yaoundé, Cameroon.

INTRODUCTION: Adrenal tumors are often found incidentally during abdominal imaging. Functioning adrenal tumors are less frequent than these incidentalomas discovered unexpectedly. We report treatment outcomes (major complications) of 7 cases of symptomatic adrenal masses from 2009 to 2019. PRESENTATION OF THE CASES: Seven cases of functioning adrenal tumors: four adenomas presenting with Cushing's syndrome, two adrenal carcinomas, and one pheochromocytoma are described. The preoperative diagnoses were made through clinical manifestations, an increase in urinary free cortisol with normal ACTH, elevated metanephrine and enlarged masses on CT. The diagnoses were established on histopathology of adrenalectomy specimens. Adrenal insufficiency in two patients following surgery was corrected with corticoid replacement therapy. One patient died of hypovolemia the day of surgery and another from anaphylactic shock (allergy) late in the post-operative period. DISCUSSION: Pre, intra and post-operative complications from vascular instability often complicate surgery in functioning adrenal tumors. Adrenal adenomas manifest as Cushing's syndrome in 10-15 % of patients. They are the most common adrenal tumor although the diagnosis is most often coincidental to abdominal imaging. The incidence of adrenal adenoma increases with age, up to 7 % in the seventh decade. Laparoscopic adrenalectomy, which was not available in our hospitals then, is standard treatment for most tumors. It is alleged to have better outcomes in trained and tested hands. CONCLUSION: Surgery of functioning adrenal tumors demands close collaboration of multiple clinical disciplines to manage vascular instability and adrenal insufficiency, especially in resource strapped communities.

Acute Urinary Retention in the Male Child from Urethral Calculi: A Report of Three Cases.

Urinary stones are uncommon in children. Urethral location of calculi can give rise to various clinical manifestations. We report three cases of urethral lithiasis presenting with acute urinary retention in children.

Challenges in the Diagnosis and Management of Acquired Nontraumatic Urethral Strictures in Boys in Yaoundé, Cameroon.

Introduction. Urethral strictures in boys denote narrowing of the urethra which can be congenital or acquired. In case of acquired strictures, the etiology is iatrogenic or traumatic and rarely infectious or inflammatory. The aim of this study was to highlight the diagnostic and therapeutic difficulties of acquired nontraumatic urethral strictures in boys in Yaoundé, Cameroon. Methodology. The authors report five cases of nontraumatic urethral strictures managed at the Pediatric Surgery Department of the YGOPH over a two-year period (November 2012-November 2014). In order to confirm the diagnosis of urethral stricture, all patients were assessed with both cystourethrography and urethrocystoscopy. Results. In all the cases the urethra was inflammatory with either a single or multiple strictures. The surgical management included internal urethrotomy (n = 1), urethral dilatation (n = 1), vesicostomy (n = 2), and urethral catheterization (n = 3). With a median follow-up of 8.2 months (4-16 months) all patients remained symptoms-free. Conclusion. The authors report the difficulties encountered in the diagnosis and management of nontraumatic urethral strictures in boys at a tertiary hospital in Yaoundé, Cameroon. The existence of an inflammatory etiology of urethral strictures in boys deserves to be considered.

High-grade intra-epithelial neoplasia and prostate cancer in Dibombari, Cameroon.

High-grade prostatic intra-epithelial neoplasia (HGPIN) occurs a decade earlier in men of African descent in the US and Brazil, compared to white men. Prostate cancer incidence and mortality is worse in the African-American than in US white men. Sub-Saharan Africa was thought to be a low incidence area. This disparity has been attributed to lifestyle factors such as diet. We report the results of prostatic biopsies, from an ongoing national prostate cancer survey. One hundred and eleven men aged 40 y and over were recruited for medical interview (AUA symptom score), prostate specific antigen (PSA) assay and digital rectal examination (DRE). Between six and 10 cores of random digitally guided needle biopsies were performed on 24 subjects that had either suspicious prostates on digital rectal examination +/ or PSA > or =4 ng/ml. All lesions of the prostate were described on routine histopathology. The Gleason score and proportion of tissue involved with cancer, was determined. Eight men had benign prostatic hyperplasia (BPH), six had cancer, another six had low grade intra-epithelial neoplasia, two had HGPIN, there was one case of BPH and chronic prostatitis and one case of chronic prostatitis only. The cancer patients were aged 58-75 y (mean 66.93 y). Gleason scores ranged from 5 to 9, there was one score of 3. Cancer made up 20-80% tissue samples. HGPIN was found in two cases (mean age 58 y). Significant prostate cancer and the pre-cancerous lesion HGPIN exist in Dibombari, Cameroon. The purported low incidence of prostate cancer may reflect cultural and economic barriers to health care.

Expression of soluble urokinase plasminogen activator receptor may be related to outcome in prostate cancer patients.

The urokinase-type plasminogen activator receptor (uPAR) exists as a GPI anchored glycoprotein (Mr=50-60 kDa) on the surface of various cell types. This receptor can be bound by or cleaved by urokinase. The cleaved receptor, soluble urokinase-type plasminogen activator receptor (suPAR), with an Mr=35 kDa has no known physiological function and can be identified circulating in the blood of normal individuals. Although no function has been characterized, the soluble receptor has been reported to be of clinical significance. The objective of this study is to characterize novel serum markers that can be used for the early detection of prostate cancer and to predict patient prognosis. Thirty-nine patients at the University of Yaounde I, Yaounde, Cameroon, West Africa were examined for prostatic disorders. Of these, 46% were diagnosed with benign prostate hyperplasia (BPH), while 44% of the patients were diagnosed via biopsy with prostate cancer and graded accordingly. Here we show that serum from patients with BPH or prostate cancer contains elevated levels of suPAR. To examine the significance of suPAR as a diagnostic factor, we used a suPAR ELISA kit and compared these results with serum levels of prostate specific antigen (PSA), the current diagnostic marker for prostate cancer. PSA and serum suPAR levels in BPH and cancer patients were greatly elevated in the majority of patients, while others had undetectable levels of either. Serum levels of suPAR were high in cancer patients as well as, although to a lesser degree, in patients with BPH. Cancer patients who died during the follow-up period were found to have consistently higher serum suPAR levels than correlating serum PSA levels. These preliminary findings are the first evaluating serum suPAR levels as a possible diagnostic marker for the early detection of prostate cancer and for the prediction of patient prognosis.

Pediatric urolithiasis in sub-saharan Africa: a comparative study in two regions of Cameroon.

OBJECTIVE: To determine the composition of caculi and the predisposing factors for stone nucleation and growth in children from two regions of Cameroon. METHODS: This was a cross-sectional study involving 21 children, 17 from the northern and 4 from the southern region, over a 6-year period. Data on age, diet, residence, clinical presentation, location of stone, and results of stone analysis were collated following a preestablished proforma. A computerized analysis of the data was carried out. The constituents of stone sections and nidus were assembled so as to determine the principal causes of stone nucleation and growth. RESULTS: Pediatric urolithiasis was more common in the northern Sahelian belt of Cameroon. Males and rural dwellers were more commonly affected. Endemic (bladder) stone disease was found in the majority of the patients. All stones were mixed. The most frequent constituents of the stones were ammonium urate, struvites, and whewellite in descending order of percentage mean volume per stone. The nidus was available for study in only 10 stones, and its composition revealed heterogeneity of causes of nucleation. The commonest cause for stone formation and growth were infection and hyperuricosuria (malnutrition). CONCLUSIONS: Pediatric bladder stone disease is not uncommon in northern Cameroon. Many factors combined to predispose to stone nucleation and growth, but the level of socioeconomic development was preponderant. Stone composition indicated that urolithiasis in children was a heterogeneous disorder, but hyperuricosuria, insufficient diuresis, and infection associated with malnutrition seemed to be the most common causes.

Migration and prostate cancer: an international perspective.

There are intra- and interracial differences in prostate cancer incidence and mortality rates worldwide. The environment and migration patterns seem to influence the disparities in cancer statistics. The lowest incidence rate is recorded in Chinese, followed by other Asians, South Americans, southern Europeans, and northern Europeans, in ascending order. However, people of African descent have the highest incidence so far. Until recently, African Americans in Alameda County (California) in the United States had the highest reported incidence (160/1000,000). An incidence of 314/100,000 recently was reported in African Caribbeans from Jamaica. These high rates contrast with the low incidence rates reported in continental (Sub-Saharan) Africa. Angwafo et al have reported higher age-adjusted incidence rates in Yaounde, Cameroon (93.8/100,000). They highlighted the importance of diagnostic methodology, availability of and access to diagnostic techniques and trained manpower, and adjustments for the age distribution of populations when comparing incidence rates between regions. The great disparity in cancer statistics over large geographic areas and races has oriented studies toward genes and gene products susceptible to environmental risk factors such as diet, ultraviolet rays, and cadmium, which may be associated with or causative of prostate cancer. Randomized studies on suspected risk factors and promoters of prostate cancer need to be conducted worldwide. However, caution is in order when inferences are made comparing populations with access to health care to those without.

Migration and prostate cancer: an international perspective

There are intra- and interracial differences in prostrate cancer incidence and mortality rates worldwide. The environment and migration patterns seem to influence the disparities in cancer statistics. The lowest incidence rate is recorded in Chinese, followed by other Asians, South Americans, southern Europeans, and northern Europeans, in ascending order. However, people of African descent have the highest incidence so far. Until recently, African Americans in Alameda County (California) in the United States had the highest reported incidence (160/1000,000). An incidence of 314/100,000 recently was reported in African Caribbeans from Jamaica. These high rates contrast with the low incidence rates reported in continental (Sub-Saharan) Africa. Angwafo et al have reported higher age-adjusted incidence rates in Yaounde, Cameroon (93.8/100,000). They highlighted the importance of diagnostic techniques and trained manpower, and adjustments for the age distribution of populations when comparing incidence rates between regions. The great disparity in cancer statistics over large geographic areas and races has oriented studies toward genes and gene products susceptible to environmental risk factors such as diet, ultraviolet rays, and cadmium, which may be associated with or causative of prostate cancer. Randomized studies on suspected risk factors and promoters of prostrate cancer need to be conducted worldwide. However, caution is in order when inferences are made comparing populations with access to health care to those without. (Au)

Prostatic abscesses in sub-Saharan Africa: a hospital-based experience from Cameroon.

Abscesses of the prostate are encountered less frequently today and the bacteria responsible have changed over the years. Herein we report our experience with 6 patients with varying presentations. The role of imaging techniques in diagnosis and percutaneous needle aspiration of prostatic abscesses is highlighted.

Testes tumors in a Sub-Saharan African city (Yaounde). Incident cases and histopathology.

OBJECTIVES: To determine the histologic types of testicular tumors and identify associated risk factors. METHODS: Data on clinical presentation, age, race, history of cryptorchidism or testicular trauma and histologic types, on each patient with testis tumor, were abstracted from medical records and the pathology register. RESULTS: Of 14 tumors, 11 were malignant. Five were Burkitt's and 2 non-Burkitt's lymphomas, 1 plasmocytoma and 3 seminomas. None of the seminomas occurred in black Africans. CONCLUSION: The epidemiology and histology of testis tumors in Yaounde differs considerably from other reported series. Burkitt's lymphoma is the commonest tumor. This alters the approach to the management of testicular masses. Race and geography seem to be important in the occurrence of testes tumors.

[Prostatic tumors (adenoma, adenocarcinoma) and obesity in Cameroon]. / Tumeurs de la prostate (adénomes, adénocarcinomes) et obésité en milieu camerounais.

The aim of this study was to look for an association between obesity and prostatic tumors in general in Cameroon. During a sixteen month period (1 September 1991 to 31 December 1992), we recruited 50 symptomatic patients with histologically confirmed prostatic tumors who were matched with a control of the same age. Of these patients, 36 had adenomas, 12 had carcinomas, two had both tumors. Patients' age ranged from 49 to 91 years. The difference in body weight and height between the patients and the controls was not significant. According to the Lorentz formula, there were as many obese patients as controls. Obesity was five times more frequent in the patients than the controls following the body mass index, but this difference was not significant. We conclude that in our area, there might be an association between obesity and prostatic tumors in general but our study is too small to reach a conclusion.

[Late exterioration of a postoperative cecal fistula in children. Apropos of a rare clinical case]. / Fistule caecale postopératoire tardivement extériorisée chez l'enfant. A propos d'une observation clinique rare.

The authors report a rare clinical observation of a post-appendectomy caecal fistula retardedly exteriorized, in a 18 year old adolescent, managed in the surgical service of the Yaounde General Hospital. The radical treatment was surgical and consisted in right hemicolectomy. Literature was reviewed and therapeutic indications discussed.

Is cancer of the prostate rare in tropical (black) Africa? Case series from the Centre Hospitalier et Universitaire and the Hospital General de Yaounde from 1986 to 1990.

The objective of this study was to determine the crude incidence of cancer of the prostate in a hospital-based population. Patients presenting at urological clinics were studied using a standard proforma. The settings included the urological outpatient clinics and hospital wards of the University Hospital Center (CHU) and the Yaounde General Hospital (HGY)--Institutions of the University of Yaounde I, Faculty of medicine and biological sciences, Centre Pasteur de Yaounde. Included were 447 new male patients over age 40, observed over a five-year period. All patients underwent standard clinical evaluation, laboratory and radiological studies. Patients with abnormal prostates, enlarged lymph nodes, metastatic bony lesions had tissue removed for histology. Seventy-two patients with abnormal prostates had them biopsied. Five had excisional biopsy of enlarged supraclavicular lymph nodes in addition to abnormal prostates. Six patients with bony lesions, elevated prostatic acid phosphatase (PAP) and prostate specific antigen (PSA) did not have tissue diagnosis. Thirty-three patients were treated with orchidectomy and fefosterol (ST-52) and 12 with ST-52 only. Seventy-eight out of 447 patients had abnormal clinical findings. 39 of these had a tissue diagnosis of adenocarcinoma of the prostate. Six others with probable cancer of the prostate did not have a tissue diagnosis. All but one patient with stage C disease had stage D disease. The calculated age-adjusted incidence of cancer of the prostate is 93.8 cases per 100,000. Cancer of the prostate is common in the blacks of Cameroon and its incidence is increasing annually.

Extraintestinal amebiasis.

Extraintestinal involvement is a dreaded complication of amebiasis, with a reported mortality rate of 7%-14%. The authors retrospectively studied 188 patients with extraintestinal amebiasis confirmed by means of clinical, surgical, and radiologic criteria over a 45-month period. Ultrasonography (US) was the mainstay of radiologic investigation. Liver abscess was present in 183 patients (97%); five patients (3%) had other organ involvement but a normal liver. The majority of liver abscesses were in the right lobe. US is recommended for the diagnosis and follow-up of patients with extraintestinal amebiasis. It is noninvasive, simple, easily reproducible, and less expensive than computed tomography. Portable models can be taken into remote areas of the less-developed world.

Urethral lengthening and reimplantation for neurogenic incontinence in children.

We describe our experience with a urethral lengthening-reimplantation operation for the correction of incontinence in 13 myelomeningocele children, 11 of whom had failed to achieve continence on a program of intermittent clean catheterization. The procedure involves lengthening the urethra by formation of a bladder tube, which is reimplanted back into the bladder through a submucosal tunnel. This procedure allows a catheter to be passed but prevents urine from leaking. All of the operated cases are included. All of the children are out of diapers and socially dry. Followup ranged from 8 to 36 months and the problems encountered are described.

Ureteroarterial and ureterosigmoid fistula associated with polyethylene indwelling ureteral stents.

Iliac artery-ureteral fistulas are uncommon, with less than 15 cases described in the literature. Ureterocolic fistulas have been described even less frequently. We report the first case of synchronous right ilioureteral and left ureterosigmoid fistulas associated with indwelling ureteral stents. The patient presented with massive sentinel gross hematuria, urosepsis and chronic anemia.