[Treatment of early T1 small T2N breast cancers. Our experience at the Yaounde General Hospital. 21 cases]. / Traitement des cancers du sein aux stades précoces T1 petit T2 N-notre experience a l'Hôpital Général de Yaoundé. A propose de 21 cas.

From February 1989 through February 1993, a group of 23 patients suffering from T1 mammary carcinoma small T2 N-MO was treated in the radiotherapy department of the Yaoundé General Hospital, according to a simplified procedure. A first conservative surgery of tumorectomy type (3 cases) and quandrantectomy type (4 cases) was carried out, followed by a postoperative irradiation. In 14 cases, a Patey type radical surgery preceded a local/regional radiotherapy. The general treatment was made up of only a hormonotherapy without chemotherapy. After a 4-year decline, there were 5 cases--i.e. 23.8%--of ganglionic and/or metastatic relapse. In the light of research data, we are analysing the reasons for these unexpected therapeutic failures in this group of tumor considered as favorable prognosis. We raised the problem of the inability of the prognosis factors, presently defined by means of histological and biological factors, to detect all the especially aggressive cancers. We carried out a general review of the new factors defined essentially from molecular and genic bases. We offered an approximative solution which makes it possible to by-pass the technological difficulties in having access to the new factors.

Laparoscopic fimbrioplasty and neosalpingostomy. Experience of the Yaoundé General Hospital, Cameroon (report of 194 cases).

OBJECTIVE(S): To study the fertility results after laparoscopic distal tuboplasty and compare them with the data in the literature. STUDY DESIGN: 194 laparoscopic distal tuboplasties were carried out from May 1992 to May 1994 in the Yaounde General Hospital (Cameroon). The results were analysed according to the age of the patients, the type and duration of infertility, past history of abortion, laparotomy and Chlamydia trachomatis infection, the tube and adhesion scores, surgical procedures and achievement of pregnancy. The fertility rates were calculated according to Cramer's method [11]. The cumulative pregnancy rate curves were drawn up from the life table [12] and compared using the Log-Rank test. RESULTS: 53 patients obtained pregnancy (27.3%) of which 45 were inter-uterine (23.2%) and 8 ectopic (4.1%). Of the 45 intra-uterine pregnancies (IUP), 36 were obtained after fimbrioplasty (33.3%) and 9 after neosalpingostomy (10.5%). The monthly fertility rate at one year was 1.4%. The rate of IUP for tube stages I and II is significantly higher than that for stages III and IV (p<0.001). However the rate of ectopic pregnancies (EP) is proportional to damage to the tubes. Infection with Chlamydia trachomatis, and residual inflammation could have an effect on the achievement of pregnancy. CONCLUSION(S): Our results are similar to those found in the literature. The tube stage thus remains the decisive factor in terms of fertility (Cox: p<0.001). Operative laparoscopy is the best alternative in our countries compared with laparotomy for distal tubal pathology.

[Blunt trauma of the liver. An analysis of a series of 29 cases]. / Traumatismes fermés du foie. Analyse d'une série de 29 cas.

Twenty nine patients with blunt liver trauma were recorded in the Central Hospital of Yaounde between 1986 and 1996. The average age was 23.4 years, with the 20 to 25 and 5 to 15 age groups being the most affected. The most characteristical clinical presentation was hemoperitoneum with shock. Twenty-three patients were operated (18 in emergency and 5 secondary). While 6 patients benefited from non operative treatment due to their stable hemodynamic state. Exploration of lesions revealed 16 grade I and grade II, 8 grade III and 5 grade IV and V lesions. The operation was a simple suture in 13 cases, selective ligature of hepatic artery in 2 cases and 2 tamponades while in 4 cases the treatment was inactive. The bleeding could not be controlled in 2 cases. Peri-operative mortality was 17.39% and morbidity 21.74%, made up mainly of parietal sepsis. In our practice, blunt liver trauma are generally benign and treatment should be conservative.

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.

[Liver trauma: analysis of 42 cases in Yaounde]. / Traumatismes hépatiques: analyse d'une série de 42 cas à Yaoundé.

Forty-two cases of liver trauma were reviewed at the Central Hospital of Yaounde between 1984 and 1994. The mean patient age was 22 years, the most commonly involved age group being between 20 and 35 years. Trauma was blunt in 24 cases (57.1%) and penetrating in 18 cases (42.8%). Diagnosis was achieved most frequently by abdominal needle puncture confirming hemoperitoneum. Emergency surgery was performed in 38 cases. In the remaining 4 cases hemodynamic status was stable and surgery was not required. Lesions were classified as grade I and II in 24 cases, grade III in 5 cases, grade IV in 3 cases, and grade V in 1 case. In the remaining 9 cases the grade of the lesion was not mentioned. Management consisted of simple suture in 26 cases, debridement in one case, packing in 4 cases, and a watchful attitude in 4 cases. In 3 cases hemorrhage was uncontrollable. Overall perioperative mortality was 14.2%. The main complication was parietal sepsis which occurred in 6 cases. In the present African series liver trauma was most often benign. This finding suggests that a conservative surgical approach is indicated.

[Developing cancer from a probable misdiagnosed pancreatic cystadenoma]. / Cancérisation d'un probable cystadénome pancréatique méconnu.

This paper reports the malignant transformation of a benign pancreatic cyst treated by internal drainage in a 30-year-old woman. The initial lesion was diagnosed on surgical biopsy of the cyst wall. The diagnosis of pancreatic carcinoma was made after one year of satisfactory course, by fine needle cytologic aspiration of the fibrous retraction of the cyst; at that time the patient had severe pancreatic pain with multinodular liver on ultrasonography. The conclusion is the recommendation of total excision of pancreatic cysts whenever the diagnosis is incomplete or imprecise.

Interet du traitement chirurgical de la cryptorchidie a Yaounde

Une etude retrospective visant a evaluer l'interet du traitement chirurgical de la cryptorchidie a porte sur 123 patients operes a Yaounde pendant une periode de 10 ans allant de 1984 a 1994. L'analyse a revele que 93 patients (75;6 pour cent) avaient ete operes apres l'age de trois ans; au moment ou des alterations histologiques avaient deja compris le pronostic fonctionnel du testicule et augmente le risque de cancerisation. Des resultats comparables dans la litterature montrent l'insuffisance de l'information medicale sur l'age optimal de l'abaissement des testicules cryptorchides. L'etude fait des propositions pour un changement de comportement

[Abscess of the rectovaginal wall in women. Apropos of a case]. / Abcès de la cloison recto-vaginale chez la femme. A propos d'un cas.

Recto-vaginal septum abscess is a rare entity in women. The authors report a rare clinical observation of a recto-vaginal septum abscess in a 40 year old woman, hospitalized and treated in the Surgical Unit of the Yaounde General Hospital. Medical literature was reviewed and surgical indications discussed.

[Problematic management of tumors with a very high proliferation coefficient: a case of an embryonal rhabdomyosarcoma of the right orbit in an eleven-year-old child]. / Problèmatique de l'approche thérapeutique des tumeurs à coefficient de prolifération très élevé: a propos d'un cas de rhabdomyosarcome embryonnaire de l'orbite droit chez un enfant de 11 ans.

We propose through the retrospective analysis of this document, to explain the inefficiency of the action of chemo and radiotherapy on tumours with a high proliferation coefficient but which are however known to be highly sensitive as well as curable with chemo and radiotherapy. This study shows the technical conditions and dispositions for a better therapeutic approach in these tumours with a rapid growth.

[Posterior urethral valves in children. Apropos of 22 cases]. / Les valves de l'urètre postérieur chez l'enfant. A propos de 22 cas.

We reviewed 22 cases of posterior urethral valves over a five year period (January 1986 to December 1990). We looked at initial management before referral to the urologist, treatment and those factors that influence the outcome. We found that nosocomial infection from catheters was the major source of morbidity and mortality. Other determinants of outcome included postobstructive diuresis and the presence of refluxing or obstructing megaureters. The age of the patients was not as important as the degree of obstruction in this group of patients. We recommend percutaneous cystostomy as initial management for these patients as opposed to urethral catheterisation. This should be followed by antegrade or retrograde valve ablation one week later depending on the size of urethra.

Maladie ulcereuse gastro-duodenale : acces aux moyens de diagnostic et de traitement en milieu tropical

Une etude prospective portant sur l'analyse des antecedents de 72 malades operes au CHU de Yaounde d'un ulcere gastro-duodenal complique avait pour but d'evaluer l'acces des malades aux moyens de diagnostic et de traitement pendant la maladie ulcereuse et pendant les complications. Les stenoses etaient la complication chirugicale la plus frequente (69;4 pour cent) devant les hemorragies (16;6 pour cent) et les perforations chez 43 malades (59;7 pour cent). Les examens diagnostiques avaient ete demandes chez 25 malades (34;7 pour cent); dont 9 TOGD et 6 fibroscopies; chez les 15 malades ayant eu une complication sur un ulcere connu; 5 malades (33;3 pour cent) avaient pu suivre dans le passe un traitement medical correct. Avec la survenue des complications; tous les malades ont eu acces aux moyens de diagnostic; dont 50 TOGD et 6 fibroscopies pour le diagnostic des hemorragies et et 8 radiographies de l'abdomen sans preparation pour le diagnostic des perforations. Apres le traitement chirurgical 6 malades (8;5 pour cent) ont poursuivi un traitement medical correct pendant 45 jours. En conclusion; cette etude montre que peu de malades souffrant de maladie ulcereuse gastro-duodenale ont acces aux moyens modernes de diagnostic et de traitement en milieu tropical. Une meilleure politique sanitaire s'impose en vue de controler cette maladie avant la survenue des complications

[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.

[Benign giant epignathic teratoma in the newborn. Apropos of an unusual clinical case]. / Tératome épignathe géant bénin chez le nouveau-né. A propos d'une observation clinique exceptionnelle.

A rare case of giant epignathus teratoma with intracranial extension is reported in a male newborn. Pre-operative diagnosis of teratoma was made or suspected on radiological evidence of calcification within the tumor and increased level of alpha-foetoprotein. Optimal treatment consisted in complete surgical resection. The literature is revisited and surgical indications are discussed.

[Value of pedicled myoplasty in the treatment of severe mediastinitis. A case report]. / Intérêt de la myoplastie pediculée dans le traitement des médiastinites graves. A propos d'un cas.

Sternotomy is the approach of choice for cardiac surgery. Mediastinitis is a rare complication of median sternotomy with high morbidity and mortality. We describe a case of severe mediastinitis occurring after median sternotomy performed in a patient presenting diving goiter. Two-stage irrigation/drainage was unsuccessful. This failure led to opening of the chest and coverage with a pediculated flap using the grand pectoralis muscle. This stratagem allowed complete healing. This case provides an opportunity to discuss the different surgical techniques used to treat severe mediastinitis and to emphasize the value of muscle flaps in the management of recalcitrant median sternotomy wounds.

[Ectopic pregnancy in tropical climate. An ultrasonographic study of 93 consecutive cases]. / La grossesse extra-utérine en milieu tropical. Une étude échographique de 93 cas consécutifs.

BACKGROUND AND PURPOSE: Ectopic pregnancy (EP) is common in Cameroon, and incidence is increasing. Ultrasound (US), has been shown to play a key role in its diagnosis, particularly when the transvaginal (TV) route is used. The purpose of our work is to describe sonographic features of EP, and to assess the role of the transvaginal route in the diagnosis of this disease in our environment. PATIENTS AND METHODS: The study was prospectively carried in the US unit of the Yaoundé University teaching Hospital (Cameroon) during a 2 year period. 502 patients aged 14 to 45 were included because of clinical suspicion of EP. The criteria for sonographic diagnosis of EP were the presence of an embryo outside the uterus, a ring-like adnexal structure, or complex adnexal mass separate from the ovaries, in conjunction with free peritoneal fluid. The EP was considered ruptured if significant fluid was found in the upper peritoneal recesses. The diagnosis was confirmed by laparoscopy or laparotomy. RESULTS: Ninety six patients were found to have an EP. 56 patients had only TV pelvic US, 13 had both TV and TA routes, and 24 patients had only TA pelvic US. The mean age was 29 years (interval: 17-42). The main clinical findings included: pain (88%), amenorhea (84%), bleeding (72%), cardio-vascular instability (14%), pelvic mass (9%). The pregnancy was tubal for 93 patients, and abdominal for 3. It was ruptured for 46 (49%). Adnexal abnormalities were present for 86 patients (92%). These were a gestational sac (78%) with a living embryo in 31 patients (33%), or a complex adnexal mass (15%). Uterine findings (40%) included: endometrial thickening (20%), pseudosac (19%), fibroids (6%). An ovarian cysts was present for 10 patients. As a rule, TV route delineated all these findings better than the TA route. CONCLUSION: An exceptionally high proportion of EP was seen after rupture in this study. Our recommendations include: educate patients to seek immediate medical advice for any missed period associated with pain, increase health providers' awareness of EP, and promote availability of TVUS.

[Diagnostic problems apropos of 2 clinical cases of lumbar Pott's disease]. / Problèmes diagnostiques à propos de deux cas cliniques de mal de POTT lombaire.

Two cases of POTT's disease without radiological osteoarticular destructions have been diagnosed from a psoas and a dorsal abscess. Bacteriology and histology were negative at the beginning, then became positive after a long evolution of the wound. The recommendation is to think of POTT's disease when confronted with any paravertebral abscess, with or without radiological signs and to repeat the bacteriological and histological tests if necessary.

[Treatment of a neglected traumatic perforation of the cervical esophagus by a muscular flap from the sterno-cleido-mastoid muscle. Apropos of a case]. / Traitement d'une perforation traumatique négligée de l'oesophage cervical par plastie musculaire du sterno-cléidomastoïdien. A propos d'un cas.

The diagnosis and management of oesophageal perforation is quite a problem. When the perforation is diagnosed early, treatment is easy with subsequently good results. When the diagnosis is delayed, treatment become complex, with a morbidity rate of about 35% and a high morbidity. This simple case report, describe the use of a sternocleido-mastoid muscle flap in the repair of a traumatic cervical oesophageal perforation with important loss of substance.