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Biomedical subjects

A Faye

Publications and source records attributed to A Faye.

At least 55 records · Page 3Linked to original sources

[Cytomegalovirus retinitis in children with AIDS acquired through materno-fetal transmission].

PURPOSE: To describe the clinical feature and the outcome of CMV retinitis in children with vertically transmitted HIV infection. RESULTS: Five case-reports of cytomegalovirus retinopathy are described. These children from eight month-old to seven and a half year-old (median age at diagnosis 52 months) had been perinatally contaminated by the human immuno-deficiency virus. The ophthalmic signs included only a red eye for one patient. The clinical signs were similar to the adult's retinopathy. At the opposite the differences were emphasized like the clinical onset with a delayed diagnosis. Mean follow-up since diagnosis is 8 months with 3 patients still alive. CONCLUSION: CMV retinitis in vertically transmitted AIDS can occur early in childhood and must be checked systematically in the patients with low CD 4 count because of the usual asymptomatic onset.

AIDS-Related Opportunistic Infections↗

[Embryo transfer in a Senegal village environment].

This study aims to identify the embryo transfer constraints and production costs at a village level in the district of Kolda (Senegal). Fifteen (15) donors cows were superovulated using 2500 UI PMSG (group A n = 8), 32 mg of FSH (group B n = 3) and 36 mg of FSH (group C n = 4). The average number of yellow bodies that were palpated was 5.06 and the mean rates of collected embryos were 5.66 for group A, 2.5 for group B and 3.3 for group C. The average transferable embryos were 2.33 for group A, 0 for group B and 1.4 for group C. The identified constraints are nutritional, healthy, social and logistic nature. The average cost of a produced and transferred embryo amount respectively to 75.940 F CFA and 99310 F CFA. Embryo transfer can fit in with a dairy production development plan in Senegal.

Animals↗

[Stage III and IV epithelial ovarian cancers. Therapeutic problems].

Between 1986 and 1989 (4 years), 11 epithelial malignant tumours of the ovary were treated in the department of gynecology and obstetrics of the Libreville teaching hospital group. Epithelial tumours accounted for 78 per cent of malignant tumours in the adult. Burkitt's lymphoma predominated in young girls. Cancer of the ovary takes sixth place among female cancers in Gabon, with an incidence identical to that of cancer of the liver. Cases involved stage III and IV malignancies. Four patients died (36 per cent) and seven are still alive (63.6 per cent) with a mean survival of 25 months at the time of the study (the longest living patient having a survival of 5 years). The fullest possible initial surgical excision is essential in ensuring the greater efficacy of polychemotherapy (including Cisplatin), the only guarantee of total second look surgery. Monitoring of residual disease was based upon ultrasonography. Pelvic radiotherapy was used in the presence of a residual pelvic mass measuring less than 3 cm. Future efforts must be direct towards early detection, in particular since more than 45 per cent of our patients were aged under 30.

Adult↗

[Recurrent extra-uterine pregnancies. 63 cases treated at the Hospital Center of Libreville from 1985 to 1989].

Ectopic implantation of the fertilised ovum, whether for the first time or as a recurrence, is not uncommon in this department. In a study in the Libreville Hospital group from 1985 to 1989, the authors found 828 cases of ectopic pregnancy (EP) including 63 recurrences, i.e. 7.61 per cent. These recurrences most often involved young women (26 per cent of cases) and nullipara (30%). The chief common etiology for the first occurrence remained tubal infection (57.28 per cent of cases). Treatment consisted most often of radical macrosurgery because of the advanced state of tubal disease, thus leading to the permanent sterilisation of 48 patients, i.e. 71.2 per cent of recurrences. Nineteen patients had a history of previous conservative surgery, including 8 homolateral recurrences (43 per cent). Reducing the incidence of such pathology essentially involves the prevention of gynecological infections, and in particular sexually transmitted diseases, as well as the possibility of early diagnosis of EP. Despite the fact that it seriously compromises the subsequent fertility of these young patients, total salpingectomy remains the treatment of choice for avoiding recurrences.

Adolescent↗

[Serology of Chlamydia and ectopic pregnancies. Incidence of Fitz-Hugh-Curtis syndrome].

The authors report a prospective study of anti-chlamydia trachomatis serology in extra-uterine pregnancies, which happened to coincide with an increase in the ectopic rate during the year 1989 (p less than 1.10(-6]. The subjects of the study were those patients operated on for ectopic pregnancy between the 1st January and the 31st May 1989. There were two control groups: the first were those that were delivered and the second were those pregnant women who were at risk of ectopic pregnancy because of their age, or the number of pregnancies they had had and their parity, without taking any account of the duration of the pregnancy. The level for sero-positive reading was 1 in 64 using an indirect immunofluorescent method (Spot IF, Bio Merieux). The results showed 81% sero-positive in those who had had ectopic pregnancies as against 63% in the control groups. The two control groups had identical readings. There was a significant difference statistically (p less than 0.01). There was no statistical difference in the incidence of HIV (human immunodeficiency virus) in the two groups (3% and 1%). The clinical study of the other tube showed no particular lesions. On the other hand, adhesions between the liver and the diaphragm (Fitz-Hugh-Curtis Syndrome) were demonstrated in 34% of those with ectopic pregnancy with a statistical significant level of igG above or equal to 1:128 (p 0.02). Perisplenitis was rare (3 cases). Histological finding of salpingitis isthmica nodosa in 49% of cases raises the problem of the pathology of chlamydial lesions being due to a host invader reaction. The increase in the incidence of ectopic pregnancy (1 in 44 deliveries) was accompanied by an increase in the prevalence of chlamydia trachomatis in the group with ectopics and the control groups. If the frequency of ectopics creates a major problem of public hygiene, the prevalence of chlamydia in the female population, apart from its effect on fertility, explains the action of sexually transmitted diseases as a factor in the heterosexual transmission of HIV in Africa.

Adolescent↗

[Indications for cesarean section and their outcome at the Hospital Center in Libreville].

Over a 16-year period and 113,739 deliveries, the rate of caesarean sections in the Department of Gynecology-Obstetrics of the Centre Hospitalier of Libreville (Gabon) reaches 1.79 p. cent. Since 1985, there is a highly significant (p less than 0.001) of that rate reaching 2.33 p. cent. A comparative study of two 4-year periods (1981-1984 and 1985-1988) permits to analyze the evolution of caesarean sections. The increase is the result of an improved diagnosis of the pathology during pregnancy, especially pre-eclampsia (6.2 p. cent of indications), a better obstetrical monitoring in pelvic deliveries (7 p. cent) and screening of fetal distress (11 p. cent). The indications remain stable in mechanical dystocias and placenta praevia (40 p. cent) and for scarred uterus (19 p. cent) the rate of which remains at 1 p. cent of the deliveries. The decreased rate of perinatal mortality which has benefited from the improvement of the quality of care is not directly related to the increased rate of caesarean sections: in Africa, caesarean sections are still performed in harmful conditions for saving the mother. Maternal mortality remains high (160 of 100,000 NB) and the mortality of caesarean sections is 9 for 1,000, with only 4 p. 1,000 related to the C. section itself and not to the pathology requiring the procedure. The mortality of caesarean section is 5 times higher than that of vaginal deliveries. Caesarean sections results in uterine ruptures during subsequent pregnancies (2 p. cent of scarred uterus). The increased of caesarean sections may only be considered within the scope of concomitant improvement of prenatal monitoring, obstetrical monitoring and neonatal medicine.

Cesarean Section↗

[Büschke-Loewenstein tumor during pregnancy. Apropos of 2 cases].

The authors report two cases of Büschke-Loewenstein tumors during pregnancy. The considerable development of this giant condyloma requires a caesarean section, to prevent a possible neonatal contamination of the newborn. The course is complicated with recurrences and the treatments are disappointing during the pregnancy. After birth, regression may be spontaneous (case no. 2). Most of the time, after a surgical biopsy is performed, for an accurate pathological examination, electrocoagulation, cryotherapy or CO2 laser result in the cure of the patient. Monitoring must be long-lasting because of the risk of spinocellular degeneration and node metastases. The papillomavirus in cause is the type HPV 6 or 16 and a few cases are described with types 16, 18, 32. The high frequency of accumulated condylomas and the possibility of rapid spread make this disease very current: the human immunodeficiency virus is one of the cofactors of transformations into verrucous carcinoma.

Adult↗

Functional evaluation of gastric transplants used in esophageal reconstruction.

Gastric transplants using the Akiyama method were used to treat esophageal carcinoma in 12 patients. Endoscopic examination, prolonged manometry (greater than 30 min), and 24 h pH monitoring were performed postoperatively to evaluate functional results. All patients could swallow without difficulty at the time of examination and had no dysphagia, regurgitation, heartburn, or sensation of abdominal fullness. Histologic examinations of residual esophagus showed microscopic esophagitis in 5 patients. Percentage of time that pH less than 4 was 42.6 +/- 10.9% (mean +/- SEM) and median pH was 4.3 +/- 1.0. The manometric examination showed no 'esophageal-like' peristaltic waves, but synchronous contractions were demonstrated in 9 patients, gastric type activity in two patients, and no activity was detected in one patient. We conclude that retained gastric peristaltic function is not a prerequisite for a good clinical outcome for swallowing and that despite vagotomy, the stomach continues to produce enough acid to maintain an acidic pH.

Aged↗

[Extra-uterine pregnancy. Study of 509 cases surgically treated at the University Hospital Center of Libreville].

Extra-uterine pregnancy is the principal emergency procedure undertaken in the University Department of Libreville. We study 509 cases treated surgically between 1984 and 1987, which is a level of 16/1,000 deliveries. The incidence of rupture of the tube has driven us to search for the best possible means to diagnose the condition earlier. Ultrasound gives the best results, dropping the level of ruptured tubes from 83% in 1984 to 50% in 1987. Extra-uterine pregnancy in nulliparous patients (25% of the group) presented a third of recurrent ectopics. The anatomopathological examination of the tissues emphasizes how common acute or chronic infections of the tubes are (25%) and salpingitis isthmica nodosa (31% of cases). If sexually transmitted diseases can be prevented the incidence of ectopic pregnancies will drop. We have tried since 1986 to be conservative in our surgery hoping that a secondary plastic operation will improve the fertility of these young patients. Mortality was high (13.75/1,000 ectopics). The principal factor responsible for this high figure is the absence of blood transfusion banks which delayed resuscitation and exposed the patients to the risk of coagulation defects when surgery is practised on these patients who are still shocked.

Adolescent↗

[Surgical emergencies and pseudo-surgical syndromes in the course of acquired immunodeficiency syndromes in adults].

Numerous abdominal manifestations were noted among 600 patients undergoing treatment at Hospital Laennec for various stages of infection by the acquired immunodeficiency virus. These included violent abdominal pain in 30% of cases, the development of abdominal lymphoma, and occasionally alarming pseudo-surgical syndromes. Diagnosis is difficult, all the more so since authentic emergencies may be aggravated by the immunodeficiency state. 18 cases were collected in 3 years and included 6 cases of acute cholecystitis and 2 of appendicitis. The gangrenous and extensive nature of infection was generally noted and required appropriate antibiotic therapy.

Abdominal Pain↗

[Perinatal and maternal risks in multiple pregnancies].

The perinatal risk in multiple pregnancies is part of the traditional gabonese culture. The authors study the perinatal mortality of twins which is four times higher than in single pregnancies. Prematurity represents the main etiology: 30 p. cent of twin deliveries occur before 32 weeks. The fetal prognosis improves from 2,000 g but deteriorates beyond 2,500 g, emphasizing the role of intra-uterine hypoxia aggravated by the obstetrical trauma. The increased mortality of the second twin, which was demonstrated by all, and the birth delay, become harmful beyond 30 minutes. The maternal pathology consists in frequent hypertensive complications and severe gravidic anemias. The maternal mortality is three times higher than in single deliveries and is related to delivery haemorrhages. The authors propose to improve the prognosis with early ultrasonographic diagnosis and pregnancy monitoring, along with social measures covering a number of prenatal tests, with hospital delivery supervised by obstetrical and neonatal teams. On the contrary, they do not believe that caesarean section is a determining factor in the improvement of fetal prognosis.

Female↗

[Maternal mortality at the Hospital Center of Libreville (1984-1987)].

Maternal mortality at the University Hospital of Libreville was 152.5 for every 100,000 live births. There were 48 maternal deaths out of 31,799 deliveries carried out between 1984 and 1987. The principal causes were: haemorrhage in 45.8%, infections in 20.8%, intercurrent diseases in 20.8%, vasculo-renal syndromes in 10.4% and thromboses in 2%. The main differences between this country and developed countries were the large number of haemorrhages and the rarity of thrombosis. Poor prognostic factors were SS sickle-cell disease in 10.4% of the cases who died and in deaths due to anaemias, of which 25% were due to haemorrhage connected with the afterbirth. Complications occurring in the 1st trimester of pregnancy caused nearly a third of all maternal deaths. Complications of abortion occurred in 16.6% and of extra-uterine pregnancies in 14.6%. If the maternal mortality rate is to be reduced it is important to have a proper blood bank. The risks of caesarean section are ten times greater than of vaginal delivery, although it is a good way out for difficult situations. The indications for the operation have to be carefully considered. Comparing the statistics reported from Cotonou, the University Hospital in Libreville has a lower incidence of maternal mortality but it is too high and requires real progress to be made.

Abortion, Induced↗