[Complications of laparoscopic surgery in gynecology unit A of Yaoundé General Hospital, Cameroon]

The aim of the study was to describe the morbidity and mortality of gynaecological laparoscopy in a pilot center of Cameroon. It was a monocentric retrospective study over a period of seven years. All files of patients who had laparoscopic surgery in the service were reviewed. Files with incomplete information were excluded. Complications were defined as an event that had modified the usual cause of the procedure or of the postoperative period. They were classified as surgical complications (during insertion of Veress needle and trocarts, intraoperative and postoperative complications) also reorganised as major and minor complications and anaesthetic complications. The rate of laparoconconversion was noted. The data of 609 patients was gathered and examined. Their mean age was 31.57 (19-63years). The mean parity and gestity was 0.77 and 1.82, respectively. The common findings in their past history were sexually transmitted infection (39.9%), criminal abortions (35.03%) and previous surgery (39.1%). Infertility was the main indication of the surgery (76.3%) followed by postmyomectomy adhesiolysis (15%). The main operative findings were adhesions (78.16%). The mortality rate is 0.16%. The surgical morbidity rate is 2.46% with 0.99% of complications during insertion of Veress needle and trocarts and 1.48% during surgery. Among these complications, 1.8% were minor complications and 0.66%, major ones. Five patients had complications due to anaesthesia (0.82%). Postoperative complications (8.3%) were of low gravity and were mainly digestive, infectious and moderate vaginal bleeding. The rate of laparoconversion was 2.46%, mainly due to difficulties during surgery. This study shows that operative gynaecologic laparoscopy is associated with acceptable mortality and morbidity rate in our milieu.

[Fetal ultrasound biometry in a Cameroonian population: study of femur length]

The length of the fetal femur was measured by fetal ultrasonography in Cameroonian population as a preliminary step in constructing local curves for fetal growth. This prospective cross-sectional study was conducted in 3 centers in Yaoundé, Cameroon over a period of one year. A total of 803 pregnant women (mean age, 27.15 years) knowing the exact date of the last menstrual period (LMP) were included. Based on ultrasound findings demonstrating a single fetus with normal development. Gestational age ranged from 12 to 42 weeks of amenorrhea (WOA). The mean length of the femur increased from 16.61 +/- 2.25 mm at 13 WOA to 75.36 +/- 4.85 mm at 42 WOA. There was a good correlation with gestational age and findings reported in the literature. Curves obtained using these data were compared with those in the literature. In most cases femur lengths measured in Cameroonian fetuses were slightly longer than European standards throughout pregnancy.

[Neurological disorders and endemic goiter: comparative analysis of 2 provinces in Togo]

Neurological diseases are one of the main causes of high mortality and morbidity in developing countries. The prevention of these diseases is possible if they are well known. The purpose of this study was to evaluate the prevalence and the distribution of the main neurological affections in two rural districts. WHO research protocol for measuring the prevalence of neurological disorders in developing countries was used by the same staff. The first survey was conducted in Kloto from July to August 1989 on 19,241 inhabitants and the second in Akébou from January to February 1995 on 4182 subjects. Akébou was known as endemic goiter district. The prevalence of epilepsy was 12.3@1000 in Kloto and 13.1@1000 in Akébou. That of stroke was 2.4@1000 in Kloto versus 1.7@1000 in Akébou. The prevalence of Parkinson's disease was 0.2@1000 in Kloto and 0.2@1000 in Akébou. That of psychomotor retardation was 3.2@1000 in Kloto versus 8.1@1000 in Akébou. The prevalence of neurological cretinism was 97@1000 while that of myxoedematous cretinism was 31@1000 in Akébou. Apart from neurological disease, the prevalence of goitre was 43% in females and 26.1% in males in Akébou. Mental retardation and cretinism were frequent in Akébou, a district endemic for goitre. Besides stroke and febrile convulsions which predominated in Kloto, the main neurological disorders were most prevalent in Akébou. Community based care for epilepsy is provided in these districts as is the prevention of iodine deficiency in the Akébou district with the intention of reducing neurological affections.

Purification of a leucine aminopeptidase from Eimeria falciformis

A leucine aminopeptidase was purified from the oocysts of Eimeria falciformis using affinity chromatography and gel filtration techniques. It had a molecular weight of 45-50 kDa. Its maximal activity against leucyl-p-nitro anilide was at pH 8.6. It is a metallo-enzyme highly inhibited by bestatin.

An evaluation of the copper-T 380A IUD's safety and efficacy at three African centers

The use of intrauterine devices in Africa is low compared with other contraceptive methods such as oral contraceptives. This study, coordinated by Family Health International, evaluated the clinical performance (safety and efficacy) of the TCu 380A IUD in three African centers, respectively, in Cameroon, Egypt, and Nigeria from 1986-1989. The 12-month unintended pregnancy rates were low for all three centers, ranging from none to 1.6 per 100 women. The 12-month discontinuation rates for all reasons ranged from 8.8 to 26.9 per 100 women. Statistically significant differences were observed among clinics for discontinuation rates for bleeding and/or pain and for planned pregnancy. The overall performance of the TCu 380A IUDs was considered satisfactory. Thus, the limited use of IUD in Africa could be due to the lack of accessibility, lack of information about, and confidence in the method rather than to documented clinical performance.

[Management of cervical cancers in Yaounde. 111 cases]

Over a 3-year period, 111 patients presenting histologically documented cervical carcinoma were treated in the Department of Cancerology and Radiotherapy at the General Hospital in Yaounde, Cameroon. Available therapeutic modalities included surgery and radiation therapy with a mean energy of 1.25 Mev of cobalt 60 which were used alone or in combination. Therapeutic strategies had to be adapted to these poor facilities based on poor pretreatment assessment of involvement. Thirty-two patients were not treated using both surgery and radiation therapy due to either insufficient financial resources or advanced disease. Seventy-nine patients were treated with both surgery and radiation therapy in various combinations depending on initial disease stage. The low quality of results was directly related to poor pretreatment assessment of extent and the unavailability of endobrachytherapy.

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.

[Controversy on the method of sterilization during cesarean section: tubal ligation or hysterectomy? Review of the literature]

The results of tubal ligation done during cesarean section are analysed in the context of a developing country during the last eleven years (1982-1992) at the maternity of the University Hospital Centre in Yaounde (Cameroun), ring this time there were 13,759 deliveries, of which 1,062 cases were by cesarean section with 109 cases of tubal ligation and 2 cases of cesarean hysterectomy. The operative and post-operative complications are discussed and compared to that in cesarean hysterectomy. Complications are found to be more in cases of cesarean hysterectomy that in cases of tubal ligation by cesarean section. The author conclude that hysterectomy at the time of cesarean section should be restricted to those cases in which removal of the uterus is necessary to preserve the life of the patient.

[Ectopic pregnancy in tropical climate. An ultrasonographic study of 93 consecutive cases]

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.