Place du cathéter de Foley dans la prévention des récurrences des synéchies utérines après hystéroscopie opératoire au Centre Hospitalier de Recherche et d'Application en Chirurgie Endoscopique et Reproduction Humaine (CHRACERH)

Contexte : Les adhérences intra-utérines peuvent entraîner un dysfonctionnement partiel ou complet de l'endomètre avec une altération de la fertilité et du cycle menstruel. La récurrence des synéchies après l'hystéroscopie est l'un des facteurs les plus importants pouvant altérer le pronostic de fertilité en post-opératoire. Objectif : L'objectif de ce travail était d'évaluer l'efficacité du ballonnet du cathéter de Foley intra-utérin dans la prévention des récurrences des synéchies après une hystéroscopie opératoire au CHRACERH. Patientes et méthode : Nous avons mené une étude transversale comparative avec collecte de données rétrospective, sur deux ans (du 1er janvier 2016 au 31 décembre 2017), chez 35 femmes ayant subi une hystéroscopie opératoire pour des synéchies utérines. Chaque patient a été classé dans deux groupes, le groupe (I) avec ballonnet du cathéter de Foley (15 patientes) et le groupe (II) sans ballonnet de cathéter de Foley (20 patientes). Le ballonnet de la sonde de Foley n°14, était placé dans l'utérus des patientes du groupe I et gonflé avec 10 ml de solution saline normale puis était retiré 5 jours après l'opération. Une hystéroscopie de second look était réalisée deux mois après l'opération pour évaluer la récurrence des synéchies dans tous les groupes. La classification de March et al. a été utilisée à cette fin. L'analyse statistique a été réalisée grâce au logiciel SPSS 20 (SPSS Inc., Chicago, IL). Résultats : L'âge moyen était de 40,1 ± 7,0 ans avec un minimum à 29 ans et un maximum à 58 ans. L'IMC moyen était de 27,3 ± 3,8 kg/m2, avec un maximum de 20,6 kg/m2 et un minimum de 37,5 kg/m2. Vingt pour cent de la population étudiée était obèse. Les principaux symptômes cliniques étaient l'aménorrhée (25,7%), l'oligoménorrhée (22,9%) et la dysménorrhée (17,1%). Quarante pour cent (8,6% dans le groupe I vs 31,4% dans le groupe II) de la population étudiée avaient une synéchie légère, 42,9% (22,9% dans le groupe I contre 20% dans le groupe II) avaient une synéchie modérée et 17,1% (11,4% dans le groupe I vs 5,7% dans le groupe II) avaient une synéchie sévère selon la classification de March. Treize virgule trois pour cent des patients du groupe I ont eu des récurrences de synéchies contre 30% des patients du groupe II. Il n'y avait pas d'association significative entre l'utilisation de la sonde de Foley et la prévention des récurrences de synéchies (p = 0,42). Le taux de complication total était de 5,7%. L'association entre la survenue d'une complication et le groupe de patients n'était pas significative (p = 0,61). Conclusion : Dans cette étude, il n'y avait pas d'association significative entre l'utilisation de la sonde de Foley et la récurrence des synéchies. Cependant, nous avons eu un faible pourcentage de récurrences dans le groupe avec cathéter de Foley par rapport au groupe sans cathéter Foley

Breast Cancer Profile in a Group of Patients Followed up at the Radiation Therapy Unit of the Yaounde General Hospital, Cameroon.

Objective. To describe the profile of breast cancer in the patients attending the radiation therapy unit of Yaounde General Hospital. Method. From 1989 to 2009, we conducted a descriptive retrospective study based on the register and medical records of patients. Results. During the study period, 531 breast cancer patients were recorded of which 0.75% were male. Age range was 18 to 82 years, with a mean of 45.17 years. Out of these, 66.1% were less than 50 years old and 31.9% less than 40. Self detection was the discovery method in most cases (95.34% of patients). Mean delay before presentation at hospital was 10.35 months, and 54.94% had used traditional medicine before medical evaluation. Metastasis and locally advanced breast cancer at diagnosis were present in 08.13% and 62.78%, respectively. Mastectomy was used in 88.08% of patients. Conclusion. The study reinforces the position occupied by late presentation and advanced stage at diagnosis of breast cancer profile in developing countries.

Laparoscopic surgery in the Cameroon.

A new surgical section of operative laparoscopy was installed in General Hospital of Yaoundé, Cameroon, in April 1992 after many years of collaboration between the University of Clermont-Ferrand and the University of Yaoundé. A total of 735 laparoscopic operations were conducted in the first 5 years. Conditions facilitating such a project are discussed.

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.

[Peritoneal tuberculosis. Value of laparoscopy]. / Tuberculose péritonéale. Apport de la coelioscopie.

We report 6 cases of tuberculous peritonitis, focusing on the contribution of laparoscopic exploration. The initial diagnosis was erroneus in all cases: the polymorphous clinical presentations suggested another infectious disease or cancer disease. Laparoscopy was performed in 5 patients who had ascitis and in 1 with plastic peritonitis. At laparoscopy, the peritoneum showed miliary granulations and inflammatory adherences on the visceral or parietal sheats. Bacteriological analyses of the ascitic fluid were positive in only one case. The diagnosis was confirmed after culture of biopsy specimens and identification of the Kock bacilli or on the basis of objective evidence of an epithelioid giant-cell granuloma with caseous necrosis. Outcome was favorable after appropriate antibiotic therapy.

Introduction of gynecologic endoscopic surgery in an African setting.

The new operative endoscopic techniques have been fully tried in the industrialized world and have spread to all surgical specialities. These new technologies present an obvious advantage for certain gynecologic pathologies which are particularly common in Africa. For pelvic inflammatory diseases, ectopic pregnancies and tubal sterility, laparoscopic surgery enables an initial assessment of disease, a less traumatic treatment and therefore a better long-term prognosis for fertility and reduced postoperative morbidity. Recently, an operative endoscopic unit performing laparoscopic surgery and endoscopic resections was created at the Centre Hospitalo-Universitaire de Yaoundé in Cameroon. This facility is the result of close collaboration between the University of Yaoundé and the University Hospital of Clermont-Ferrand. This operative endoscopic unit has been functioning since April 1992. The authors discuss the difficulties involved in such projects, such as initial investment, maintenance of equipment and in particular training of the surgical team.

[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.