[Central precocious puberty due to hypothalamic hamartoma in Cameroon]. / Puberté précoce de cause rare au Cameroun: L'Hamartome hypothalamique.

Hypothalamic hamartoma is an uncommon cause of central precocious puberty and sometimes of gelastic epilepsy and delayed development. The purpose of this report is to describe a case of central precocious puberty in an 18-month-old girl who was referred to our department for further investigation of vaginal bleeding that had appeared during the 8th month of life. The patient's puberty was compatible with Tanner stage 3, her psychomotor development was normal, and epilepsy was not observed. Diagnosis was based on abnormal hormonal workup findings and discovery of a hypothalamic hamartoma on brain magnetic resonance imaging. Neurosurgery was not performed. Administration of long-acting gonadotropin releasing hormone analog to slow puberty led to clinical improvement. Hypothalamic hamartoma must always be suspected in case of central precocious puberty. Although magnetic resonance imaging is the most reliable modality, it is not always available nor affordable in low-income countries. Neurosurgery is not indicated in patients without epileptic seizure. Gonadotropin releasing hormone agonists are usually indicated to slow down puberty and improve the adult height. However, the cost is prohibitive in developing countries.

Neural tube defects are rare among black Americans but not in sub-Saharan black Africans: the case of Yaounde - Cameroon.

BACKGROUND: Neural tube defects (NTD) are complex malformations rare in black Americans and Japanese. The incidence related to births or community-based studies have not been published in Cameroon or in black sub-Saharan countries, except one study in the Nigerian middle belt [Airede KI. Neural tube defects in the middle belt of Nigeria. J Trop Pediatr 1992;38 27-30.][corrected]. METHODS: To evaluate the incidence of neural tube defects in Yaounde, the birth record of the maternities was retrospectively exploited during the last ten years period (1997-2006). RESULTS: A total of 52,710 births were recorded in the 03 main hospitals of Yaounde. Ninety eight (98) cases of NTD with an incidence of 1.99 cases per 1000 births were registered. Spina bifida cystica (myelomeningocele, meningocele) represented 71%, followed by encephalocele (21.1%) and anencephaly (5.4%). Periconceptional folic acid was not taken by any of the mothers in our study. Abortion of affected pregnancies is illegal in Cameroon. CONCLUSION: Neural Tube Defects may not be so rare in sub-Saharan black Africans particularly in Yaounde (Cameroon). Spina bifida is the most frequent malformation. The results of this study make a case for periconceptional folic acid supplementation in our communities. The respective contributions of racial (genetic) versus environmental (or nutritional) factors will however have to be studied in order to develop a comprehensive prevention strategy.

[Historical cohort study of delivery in women of forty years of age and older]. / Etude cohorte historique de l'accouchement a 40 ans et plus a Yaoundé-Cameroun.

In a recent study at the Yaounde-Cameroon University Teaching Hospital, we found that delivery at extreme ages of reproductive health was associated with increased foetal and maternal risks. However we were not able to evaluate the impact of advanced age on exposure do different risks observed. The purpose of this study was to test the hypothesis that deliveries of women aged 40 years and above were associated with increased risk. Data collection was retrospective from delivery room registers at the Yaoundé University Teaching Hospital Between 01/01/1991 - 31/12/2000. The deliveries of 180 women in their forties were compared with those of 532 women in their twenties. The software EPI Info 6 and SPSS were used in analysis. At unvaried analysis, the risk of delivery by caesarean section for women in their forties (16.1%) was significantly high compared to women in their twenties (10.0%), (HR: 1.7; 95% CI: 1.1-2.8; p = 0.027). After adjustment for different factors associated with the occurrence of delivery by caesarean section, its risk for women aged 40 and above remained significantly increased (HR: 1.7; 95% CI: 1.0-2.9; p = 0.039). Similar observation was found for stillbirth with 11.7% by women aged 40 and above compared to 5.8% by women in their twenties (HR: 2.1; 95% CI: 1.1-3.9; p = 0.011). After adjustment for different factors associated with mortinatality, its occurrence remained significantly increased at age 40 and above (HR: 1.9; 95% CI: 1.1-3.6; p = 0.032). Women aged 40 years and above had an increased risk of stillbirth and delivery by caesarean section than those in their twenties. Studies are needed to establish the exact causes of these risks and evaluate management options in these women.

[Outcome of delivery at extreme ages of reproductive life]. / Devenir de l'accouchement aux âges extrêmes de la vie reproductive.

BACKGROUND: Deliveries in adolescents and in elderly are separately known as associated with high foetal and maternal risks. The purpose of this study was to test the hypothesis that the outcome of deliveries might be comparable in these distinct age groups. POPULATION AND METHODS: The deliveries of 99 adolescents aged 16 and under were compared with that of 183 women aged 40 years and above with respect to complications of the delivery and the outcome of pregnancy. Data collection was retrospective using delivery room registers from 01/01/1991 to 31/12/2000. RESULTS: Some risks were comparable in both groups as delivery by caesarean section, intra uterine growth retardation, and stillbirth. Other risks were significantly higher in teenagers as post-term delivery, premature delivery, and neonatal foetal distress. The risk of macrosomia was significantly higher in aged women. CONCLUSION: There are risks that are similar in both extremes of age. Other risks are higher particularly in teenagers or in aged women. A common prenatal care unit can be used for these two categories of population, but a few different practices will have to be considered according to the specific age group.

[Burkitt lymphoma in Cameroon children: descriptive and clinico-anatomical aspects]. / Lymphome de Burkitt chez l'enfant au Cameroun: aspects descriptifs et anatomocliniques.

This retrospective study is armed to indicate the descriptive and pathological aspects of children Burkitt lymphoma in Cameroon. It was performed on a 4 year period between July 1988 and July 1992. Children from 0 to 15-year-old who were hospitalized and who had histologically provern Burkitt lymphoma were included. There were 39 patients, that is 27% of all malignant tumors in children during this period. Twenty-four were boys and 15 were girls; the median age was 90 months (+/-46) (range from 3 to 180 months). All children had Plasmodium falciparum infection. EBV serology was positive in 18 patients out of 25 (72%), 14 (36%) had a good nutritional status, the 25 other patients suffered malnutrition. Tumor localizations were: maxillary in 29 (74%) patients, abdominal in 7 (18%), other in 3 patients. Clinical stages according to Murphy classification were: stage I in 6 (15%) patients, II in 3 (8%), III in 20 (51%) and IV in 10 (26%). It is concluded from this series that clinical aspects and histological pattern in children Burkitt lymphoma in Cameroon are not different from what is observed in other endemic areas.

Pediatric hematology and oncology in Cameroon, Africa: past and future perspectives.

In Cameroon, nutritional disorders and infectious diseases account for the majority of pediatric deaths. Pediatric hematology and oncology as a subspecialty of its own is nonexistent. Cases are handled mainly in general pediatric wards. However, adult hematologists, radiotherapists, general practitioners also intervene. Diagnosis is made using available simple techniques. Treatments use adapted protocols elaborated by the lone pediatric hematologist-oncologist. Efforts are being made to create a specialized ward within the pediatric service of one of the teaching hospitals where treatment and care can be received at little or no cost.

Foetal macrosomia in Cameroon: prevalence, risk factors and complications.

102 neonates weighing 4000 g and above were compared to a control group with similar characteristics except for the weight. The sex distribution was 74.19% males and 25.81% females. The prevalence of macrosomia was 6.41%. Maternal risk factors were: age above 30 years (p < 0.05); grand multiparity P > 5(p < 0.05); post term (p = 0.001); height above 1.65 m (p < 0.001); term weight of 90 Kg and above (p < 0.001); pregnancy weight gain of 15 Kg and above (p < 0.001). Macrosomic neonates had the following complications: foetal distress, shoulder dystocia, respiratory distress and hypoglycaemia.

Childhood leukemia is still a deadly disease in Yaounde, Cameroon: a report of 14 cases.

In the Pediatric Unit of the University Teaching Hospital Center of Yaounde, 58 of 2,900 (2%) hospitalized children aged 0 to 15 years who had a malignancy were studied. Fourteen (24.1%) had acute leukemia based on morphologic and cytochemical studies. Acute lymphoblastic leukemia was encountered in 11 of these patients (78.6%). The male to female ratio was 1.3 to 1. Nine of the 11 children (64.3%) were 5 years of age or younger. Eleven (78.6%) died of disease progression and its complications.

Stroke in children in Yaounde, Cameroon.

Thirty five children aged 5 months to 15 years suffering from stroke were studied from August 1984 to July 1990 from two hospitals in order to determine the incidence, the etiological factors and the short term outcome of the stroke. The average annual incidence was 1.85 per 1000 pediatric hospitalizations. There was a progressive rise in the number of cases from 1985, with a peak in 1990. Motor impairment of one half of the body was the commonest clinical feature seen in 97.1% of the cases. Other clinical signs were: facial paralysis (62.9%) and aphasia (28.6%). The main etiological factors were: homozygous sickle cell disease (31.4%), heart disease (17.1%), cerebral malaria (14.3%) and meningitis (14.3%). No causative factor was identified in 7 patients (20%). The mortality rate was low (2.9%) and all the children had neurological deficit after a mean hospital stay of 15 days. Laboratory investigations including lipid analysis, platelet count, and skull X-rays proved to be of no diagnostic value. However, computed tomography (CT) scan confirmed the diagnosis of ischemic stroke whenever it could be done.

[Kidney tumors in Africa. Incidence and anatomo-clinical aspects. Apropos of 123 observed cases at the Central Hospital and at the University Hospital Center in Cameroon]. / Les tumeurs du rein en milieu africain. Incidence et aspects anatomo-cliniques. A propos de 123 cas observés à l'Hôpital Central et au C.H.U. de Yaoundé (Cameroun).

123 renal tumours, among which 4 benign, were observed in 13 years. Renal tumours have a low incidence in Africa and are mostly seen in young patients. Nephroblastoma is the most frequent of these tumours. The clinical and paraclinical aspects of these tumours have nothing particular but the diagnosis is usually late.

Hepatocellular carcinoma in Cameroon : sonographic findings and clinical outcome : a study of 72 cases in the University Teaching Hospital; Yaounde; Cameroon

Sonographic findings and clinical outcome of 72 consecutive patients with hepatocellular carcinoma (HCC) in the Yaounde University Teaching during a period of 20 months are reviewed. The purpose of the study was to assess the sonographic pattern and natural history of HCC in Cameroon. The diagnosis was established by fine needle biopsy; or by a combination of clinical features; elevated serum alphafoetoprotein and sonographic findings. There were 55 males and 17 females. Fifty-five (76 per cent) patients presented with hepatomegaly. Three types of HCC were found : nodular; diffuse and mixed. Twenty-two patients had significant ascites. A thrombus in a major portal vein was present in 19 patients. Ten had secondary lesions on presentation. Only one patient was operated on; but the tumour was not resectable