Le cancer de la verge à propos de deux cas. Pathologie rare : les difficultés de la prise en charge

Introduction : Le cancer de la verge est une prolifération maligne des cellules formant les tissus du pénis. C'est une pathologie rare. Le pronostic est favorable si le traitement est précoce. Notre but était de rapporter les deux cas de cette pathologie, en informant sur son épidémiologie, surtout les difficultés sur sa prise en charge. Patients et méthodes : C'est une étude de cas clinique sur deux patients présentant un cancer du pénis dans le service d'urologie du Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona d'Antananarivo, Madagascar. Les paramètres étudiés sont la prévalence et la prise en charge de cette pathologie. Résultats : Nous avons observé une diminution de la prévalence. La difficulté de la prise en charge est causée par la pauvreté. Conclusion : Malgré la rareté de cette pathologie, sa prise en charge est encore difficile dans notre pays. La difficulté est due à la pauvreté

[Osteosarcoma of the radius after intramedullary osteosynthesis]. / Ostéosarcome du radius après une ostéosynthèse par embrochage centromédullaire.

Osteosarcoma is a malignant neoplasm characterized by local lytic or plastic processes. We observed a case of radius osteosarcoma in a 10-year-old boy 3 months after intramedullary osteosynthesis in the ipsilateral distal radius. Treatment consisted of amputation of the distal humerus and adjuvant chemotherapy; no complications were observed.

[Urinary ascites, uroperitoneum and urinary peritonitis in children: management of nine case reports in Madagascar]. / Ascite urinaire, uropéritoine et péritonite urinaire chez l'enfant : conduite diagnostique et thérapeutique à propos de neuf observations à Madagascar.

OBJECTIVE: To evaluate the frequency of urinary peritonitis in children and to highlight its terms of management in a country with limited resources. PATIENTS AND METHODS: We retrospectively observed nine case reports of urinary peritonitis collected in surgical reanimation service at the CHU of Antananarivo, from 1st January 2009 to 31 December 2012. RESULTS: Urinary peritonitis accounts 0.5% of all pediatric abdominal emergencies and 5% of pediatric urological emergencies collected in our service during study period. Three etiologies were traumatic bladder rupture, one bladder iatrogenic rupture, four secondary to obstructive uropathy and one other after cystolithotomy. We found a new case of posttraumatic transverse rupture of the bladder neck. Among obstructive uropathy observed, there were two cases of posterior urethral valves and two cases of ureteralpelvic junction obstruction. Clinical expression was dominated by fever, with abdominal distention and defense. In majority of cases, etiological diagnosis was made intraoperatively. The surgical treatment by laparotomy was performed under cover of systemic antibiotic therapy. Evolution was complicated with sepsis in three cases and acute renal failure in both cases. Surgical follow-up without complication were observed in four cases. A child has died to septic shock and multivisceral failure. CONCLUSION: Unlike urinary ascites resulting a transperitoneal extravasation of urine, uroperitoneum was a fistula between adominal cavity and content of the urinary tract. Urinary ascites was a rare cause of peritonitis. In contrast, uroperitoneum caused peritonitis quickly. Urinary peritonitis was a rare entity but severe prognosis in children. In majority of cases, etiological diagnosis was made intraoperatively.

[Bladder neck traumatic rupture in children]. / Rupture traumatique du col vésical chez l'enfant.

Transverse rupture of the bladder neck injury is rare in children. We report a new case in a 10-month boy with urinary peritonitis. Diagnosis was intraoperative. Surgical treatment in emergency with urethrovesical anastomosis protected by a perivesical drain and a large-bore urinary catheter was performed without urogenital complication.

[Spontaneous intraperitoneal rupture of hydronephrosis in an infant]. / Rupture spontanée intrapéritonéale d'une hydronéphrose.

Spontaneous intraperitoneal rupture of hydronephrosis is a rare complication. We report a case in a 30-month old boy admitted for fever, with a temperature up to 38.5°C, and abdominal distension. The diagnosis was made intraoperatively. The treatment consisted of an emergency internal urinary diversion and a deferred definitive cure of the pyelo-ureteral junction stenosis. Surgical management in two steps is more prudent and beneficial.

Rupture vesicale du post partum; a propos d'un cas

La rupture secondaire vesicale intra peritoneal du post partum est rare. Nous rapportons une observation inhabituelle chez une femme de 25 ans qui etait adressee pour douleur abdominale aigue. Cinq jours auparavant; elle presentait un accouchement dystocique d'une grossesse menee a terme. Elle presentait une occlusion intestinale aigue du grele mecanique. L'abord median sus et sous ombilical permettait d'objectiver une rupture vesicale intra peritoneale et de traiter la lesion par suture en deux plans sous couvert d'une sonde uretro vesicale. La lesion vesicale etait parvenue au cours d'un accouchement dystocique sur vessie pleine. Une verification systematique du bas appareil urinaire apres toute intervention obstetricale laborieuse permet d'evoquer le diagnostic

[Anal adenocarcinoma revealed by a fistula-in-ano. Report of a case]. / Fistule périanale révélatrice d'un adénocarcinome du canal anal. A propos d'une observation.

Anal adenocarcinoma revealed by a fistula-in-ano occurs rarely. Authors report a case in a 56 year-old man. The pathogeny is still unknown. Symptomatology has no specificity and the diagnosis is often late, in an advanced stage of the sickness. Recurrent or non recurrent fistula-in-ano requires multiple biopsies for pathology analysis in order to screen a related cancer. Tumor dimension, lymph node involvement, histologic grade and treatment modality are independent prognosis factors for survival. Our objective is to show physiopathological, clinical and therapeutical characteristics from a review of the literature.

[Giant bladder calculus in two male farmers in Madagascar]. / Calcul géant de la vessie chez deux agriculteurs à Madagascar.

We report two cases of giant calculus in two male farmers in 1999. They were operated on in the urologic ward by lithocystotomy. Infrared spectrophotometric analysis, carried out in Bordeaux, gave us the main components of the stones. These stones weighed respectively 350 g and 450 g. Research of common aetiology such as vesical neck stricture, prostatic hypertrophy, urethral stricture and urinary bladder diverticula was unsuccessful in case of the first patient; in the opposite, the second one had vesical diverticula discovered operatively. But two phenomena came out from this aetiologic investigation: particular regimen of these farmers (much starchy food) and geographical situation of their health centre (far from their home). We must make general practitioners sensitive to this early signs of the disease in order to provide their patients a precocious and better care.

[Cystic cervical and mediastinal lymphangioma: a case report and review of the literature]. / Lymphangiome kystique cervico-médiastinal: à propos d'un cas et revue de la littérature.

Cervical and mediastinal cystic lymphangioma are rare and benign tumours. They looked like a lateral and cervical mass. Medical imaging allows to suspect the diagnosis but histology only may to assert it. The best therapy is surgery. Sclerosis by chemical drugs is only an alternative if surgery is not possible. A recovery is completely obtained if the whole tumour is removed.